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Today, more than ever, India is challenged to meet the health needs of its people. The India Health Systems Reform Project is motivated by the goal of advancing health system reforms in India to provide equitable access to good quality of care and financial risk protection for its citizens. The Project adopts a three-pronged strategy encompassing (1) high quality research to diagnose health systems and propose potential solutions drawing on best practices within India and from international experience, (2) policy dialogue with interested governments and non-state stakeholders to envision and test reform possibilities and evaluate their impact, and (3) executive training for health policy makers and researchers at state and national levels. Throughout, we emphasize the systemic nature of the underlying causes of health system performance, and the importance of the interactions between public and private parts of the health system.

Funding from the Bill and Melinda Gates Foundation is gratefully acknowledged.

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Issues in Public Health in India - Keynote address by Keshav Desiraju, Former Secretary of Health and Family Welfare to the Government of India

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Keshav Desiraju, Issues in Public Health in India - Keynote address by Keshav Desiraju, Former Secretary of Health and Family Welfare to the Government of India, Journal of Public Health , Volume 43, Issue Supplement_2, October 2021, Pages ii3–ii9, https://doi.org/10.1093/pubmed/fdab305

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The state of public health in India can be studied in terms of disease burden, health human resources and health care financing. There are many regional variations within these broad areas, and many complexities. Communicable and non-communicable diseases remain major challenges, as do maternal and infant mortality. At every level, trained human resources are scarce. Government budgetary resources are inadequate and the current discussion in India on universal health care appears to be biased towards privately provided care. At the same time, there have been remarkable achievements, often diminished by the size of India’s population.

Public health is about social justice and the task before India today is to demonstrate the political will, the administrative ability and the democratic vision to achieve universal health care. Can this come about?

In calling this talk ‘Issues in Public Health in India’, my intention is, quite simply, only to identify the issues which have a bearing on the health and welfare of a very large population. There are many complications and regional variations, whether in disease burden, health infrastructure, health human resources or styles of governance. There are many implications for the establishment of better health systems arising from India’s federal structure where the primary, constitutional, responsibility for health care is that of the states even if a not insignificant share of public spending on health care is by the central government.

Clearly, these issues will need to be addressed in a sensible and inter-connected manner if efficient health systems are to be built.

This talk comes at the end of a conference on mental illness and mental health, but while there are critical issues at the heart of a mental health policy or programme, it is essential that those issues are understood within the context of the health of a people, the public health context. And I would like to spend a little time on this. There can be no mental health without public health.

A good place to start is to look at what has gone wrong. In a recent piece entitled ‘Archives of failures in global health’, Professor Madhukar Pai of the McGill University looks not at the dramatic successes with which we are all familiar but at failures, areas where the global health community and individual governments have been either unable or unwilling to make a difference. 1 Several of the failures identified by Prof. Pai relate to India. These include India’s failure to invest in health, India’s premature declaration in 2005 of leprosy elimination and India’s failure to address child malnutrition and stunting. There are also situations where India is not alone but where there is still a recognized shortcoming such as the failure to deliver on the Alma Ata Declaration, the failure of the global Malaria Eradication Programme, the failure to achieve the Millenium Development Goal [MDG] 5 goal on maternal deaths, failure to address the NCD epidemic, the weakening of the campaigning to end AIDS by end-2030 and the failure to address global mental health.

This sorry list gives a very good outline of the ‘range’ of India’s public health issues. One very striking feature is the continued prevalence of communicable disease along with the rapid increase in the spread of non-communicable disease in a country where maternal and infant mortality are still unacceptably high. India is forever in a state of transition. Several developed countries have reduced maternal and infant mortality and have also brought communicable disease under control. This allows them the resources and the space to address the threat to non-communicable disease. India does not have this luxury. If we have successfully eliminated small pox and polio, we still are fighting malaria, tuberculosis, leprosy, AIDS and a string of what are rather sadly called ‘neglected tropical diseases’.

None of this is actually new. The Alma-Ata Conference on primary Health Care of September 1978 urged that ‘Governments have a responsibility for the health of their people which can be fulfilled only by the provision of adequate health and social measures’. Alma Ata also recognized the importance of promotive, preventive, curative and rehabilitative services, of nutrition and safe drinking water, of public health education, of access to drugs, immunization, family planning, maternal and child health. Most importantly, the Alma Ata Declaration recognized the need for health human resources both at the local and referral level, for ‘health workers, including physicians, nurses, midwives, auxiliaries and community workers as applicable, as well as traditional practitioners as needed, suitably trained socially and technically to work as a health team and to respond to the expressed health needs of the community’.

Communicable disease

Public health policy and practice in India has traditionally been driven by ‘communicable disease’. There have been significant achievements in the past and also very recently in the case of polio, where it has been over 7 years without an incidence of wild polio virus. India’s polio campaign was a combination of financial resources, superior technology and dedicated manpower. There have not been comparable results in routine immunization where the all India average is 62%. 2

‘Malaria and other vector borne diseases’ such as dengue still pose a major public health challenge. A reduction has been seen in the number of cases; about 9.5 million malaria cases in 2017, but 1.25 billion Indians—94% of the population—are still at risk of malaria. The government has set 2030 as the target year for eliminating malaria. 3

Despite reduction in mortality of ‘tuberculosis’ by 42 per 100 000 persons in 1990 to 23 per 100 000, India still contributes 25% of the global burden, with an estimated 2.8 million new cases in 2018. 4 The Global TB Report of 2018 reported an incidence of 28 million persons, about a quarter of the world’s cases. 5 Of these 28 million, about 1.47 million are afflicted with Drug Resistant TB, a situation which has arisen almost entirely because of unregulated treatment of tuberculosis by private providers. If India is to achieve elimination of tuberculosis by 2025, a much publicized objective, much more will need to be done.

Non-communicable disease

We also recognize the major threat of ‘non-communicable’ disease. ‘Diabetes, cardio-vascular disease and cancers contribute significantly to the disease burden’. For many years India, with the rest of the world, believed that non-communicable diseases such as hyper tension and diabetes were the result of inappropriate diet in high income countries. We now know more realistically that diabetes and hyper tension as also cancers and mental illnesses have comparatively little to do with incomes and much more to do with the now clearly identified risk factors of tobacco use, uncontrolled use of alcohol, lack of exercise and poor diet.

India, which moved the global mental health resolution in the World Health Assembly 2012 which led to the action plan adopted at the World Health Assembly 2013, has consistently called for a ‘greater recognition of the fact that mental illness be regarded as one of the major non-communicable diseases’, calling for medication, treatment and long-term management. Approximately 5% of India’s population is believed to have common mental disorder with a further 1.5% with severe mental disorder. This translates into about 80 million persons, a staggering number on any reckoning. 6

While all non-communicable ailments need continuous and regular treatment, the stigma surrounding mental illness makes it the more difficult for appropriate measures to be taken. India’s Mental Health Policy of 2014 and the National Mental Health Care Act of 2017 lay down very salutary principles which place the interest of persons with illness at the fore, and not necessarily the interest of families and guardians, and of treating psychiatrists. It is a legislation that recognizes the rights of persons with illness to appropriate treatment, a major move forward in a country where the right to healthcare is not easily understood.

Other diseases, whether communicable or non-communicable, may affect smaller number of persons but still add to the burden of disease and require appropriate responses. These include rheumatic heart disease, leprosy, thalassemia, sickle cell anaemia, congenital disorders and accidental deaths.

Maternal and infant mortality

Numbers do not tell us everything but we must still know what they are. Despite magnificent efforts, largely driven by Government, maternal mortality, nation-wide, is still at 142 deaths per 100 000 births. We were not successful in achieving the MDG target of 109 by 2015. The Sustainable Development Goals (SDGs) now require us, by 2030, to reduce the global maternal mortality ratio to less than 70 per 100 000 live births. Some states have indeed achieved this; Kerala at 61, Maharashtra at 68 and Tamil Nadu at 79 have shown what is possible but we must also recognize Rajasthan at 244, Uttar Pradesh at 285 and Assam at 300.

Infant mortality, nation-wide, is still 39 deaths per 1000 live births. SDG 3.2 requires us to reduce neonatal mortality to at least as low as 12 per 1000 live births and under-5 mortality to at least as low as 25 per 1000 live births. We were not successful in achieving the MDG of not more than 41 deaths per 1000 live births in the under-5 age group. The actual estimate in 2015 was nearer 48 deaths per 1000 live births. Here, again there is wide variation among states with Kerala at 12, Tamil Nadu at 23 and Delhi at 26 at one end of the range, already having achieved the SDG, and Odisha at 66, Madhya Pradesh at 69 and Assam at 73 at the other.

These numbers indicate the scale of the challenge. What they conceal are the details. True, more women and infants are surviving the trauma of childbirth; however, not much else is changing in their lives. Women continue to be underweight, anaemic, married too early, are becoming mothers too early and are giving birth to underweight babies at some risk of wasting and stunting. The Lancet has recently called attention to the fact that ‘Malnutrition was the predominant risk factor for death in children younger than 5 years of age in every state of India in 2017, accounting for 68·2% of the total under-5 deaths’. 7 The additional details are grim. ‘The prevalence of low birth weight in India in 2017 was 21·4%, child stunting 39·3%, child wasting 15·7%, child underweight 32·7%, anaemia in children 59·7%, anaemia in women 15–49 years of age 54·4%, exclusive breastfeeding 53·3% and child overweight 11·5%’. With 28 million babies born every year, the actual numbers are staggering. And even more recently, the 2019 Global Hunger Index places India at a rank of 102 of 117 countries assessed.

Any study of disease burden in India must, obviously, recognize population size. The relationship between health policy and population policy in India has been contentious. For too long, population policy has been seen as a question of population control and it is only relatively recently that more voices are heard, primarily from civil society, calling for a population policy that addresses the questions of women’s health, nutritional status, the ability of women within families and communities to take decisions relating to themselves, women’s literacy and education, awareness among both men and women of the options for family planning available to them and the recognition that higher standards of primary care impact significantly on the health of women and children.

It is also necessary to recognize that whatever efforts are made by India today howsoever heroic and howsoever well-funded, the impact will not really be felt for the next 15 or 20 years. India’s population today stands approximately at 1.3 billion. In population growth as well as in communicable disease, there is significant variation across the states many of whom have achieved replacement fertility rate of 2.1. Other states, more particularly Uttar Pradesh, Bihar, Jharkhand, Madhya Pradesh and Rajasthan have not yet reached this level.

More positively, in the 70 odd years since independence life expectancy has increased significantly, from 26 at independence, to 70.3 years for women and 66.9 years for men.

There is a real danger in a country of India’s size and as divided in access to resources that we concentrate only on the diseases of the urban population, of the relatively better off sections of the society, of persons who have access to health care facilities and of persons who are in a position to pay for health care. It is possible that the diseases of those persons who are unable to access health care fall outside the area of interest of health policy makers.

Health care financing

Prof. Pai’s list of failures also, significantly, highlights India’s failure to invest in health care. Most discussions of this subject tend to highlight the fact that, as against the Alma Ata objective of 3% GDP to health care, India has never gone beyond 1.1%. There are several important riders to this.

Expenditure as a percentage of GDP is by both the centre and the state, though traditionally, it is the central government that has made substantial contributions towards this. This expenditure also includes the cost of maintaining the hospitals and salaries of nurses within the government system, expenditures largely borne by the states many of whom do not find it easy to generate significant resources of their own.

We must also look at how the public expenditures are divided across infrastructure, human resources, hospital care, public health, medical education and medical research. Each of these would require a formidable level of investment and the tendency has been for both the government of India and the states to look for the low hanging fruit such as construction of hospital buildings or the purchase of expensive equipment rather than the more time consuming effort involved in investing in the education of nurses and public health workers or clinical and health research.

Most issues in health care financing are well-known but I would like to speak a little about India’s current policy as reflected in the scheme known as the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana, or Prime Minister’s Health India Programme. There has been a widely publicized, social media driven campaign promoting this Programme but it is necessary not to be diverted by the glitz of the campaign and to look at actual and projected achievements.

The PMJAY has two components. The first is an insurance-based hospital care scheme. Persons enrolled under the PMJAY are entitled to seek treatment at empanelled government and private hospitals the payment for which, up to a maximum of Rs. 500 000, for any one of 1350 packages, at prior negotiated rates, is to be made to the treating facility by the insurance company. This is the way many health insurance schemes work including the Rashtriya Swasthya Bima Yojana which India launched in 2008 and has now, for all practical purposes, abandoned. The latest figures are that 4.46 million persons have received cashless treatment in over 18 000 hospitals, and while figures are frequently released of the numbers of claims settled with hospitals, information is not necessarily forthcoming on improved health outcomes, if any.

There are several difficulties in the entire structure. Where it is government’s intention to negotiate lowest possible rates for prescribed treatment, it is the endeavour of private hospitals to increase these as much as they can, and while it is possible that negotiated rates have been announced, it is perfectly clear that private hospitals will render only as much treatment as they believe they can do so do within the negotiated rate. Another very serious problem with PMJAY is that it only supports cases of hospital admission ignoring the fact that a substantial number of cases could conveniently be dealt with in the outpatient wards. Indeed, in these cases, hospitalization probably brings on a range of unrelated additional costs not covered by the insurance payment. There is, of course, also the issue of useless hospitalization and useless surgeries being undertake only in return for the insurance claims. 8

All of this leads to the suspicion that the scheme has been designed primarily to make use of unused capacity in private hospitals. Interestingly, a recent article authored by the two senior most civil servants in the health establishment relates with some pride that more than half the hospitals empanelled under the scheme are private, and that private hospitals have witnessed a 20% increase in footfall. 9

I have said that there are two parts to the PMJAY programme. The second is the establishment of Health & Wellness Centres. This really appears to be a programme for up-gradation and strengthening of existing sub-centres and primary health centres; 12 services have been identified which the Wellness Centres are expected to provide, unlike the limited range of services currently provided, or expected to be provided, in Sub Centres or PHCs. In an ideal situation, this would have been addressed first on the understanding that the bulk of people’s health concerns would be taken care of within at the level of primary care with only more complicated cases being referred to a secondary or tertiary level, either in the government or in the private sector, where hospitalization would be more or less essential and the cost would be covered by insurance.

Comparatively, little information is available on how successfully the Wellness Centres have been established. A figure of ‘more than 20 000’ is cited in official reports. 10 Given that there are about 24 000 PHCs and over 1 56 000 Sub Centres, this is not a large number. It is also not clear whether a simple conversion of existing centres into the newly christened Wellness Centres would be able to successfully address the problems of inadequate human resources, limited availability of drugs and disposables and general poor maintenance. The eco-system in which the Wellness Centres are to function remains the same and it is not clear that renaming them has effectively solved anything. 11

There is also the more fundamental question of who should pay for healthcare. Having an insurance-based system still requires substantial amounts of government funds to be paid out as insurance premium on population cover. There is no sign in any of the annual budgets since the scheme was launched of increased funding of the order that is required to make it work. Even the Chief Executive of the PMJAY, in a much publicized interview, admitted that he hoped India’s investment in health care would reach 2.55 of the GDP by 2025, of which only a small amount would come to the PMJAY. 12 If government has not budgeted for the insurance claims which will be received in increasing volume, if it has not budgeted for the up-gradation of the Wellness Centres, it is not very clear that the scheme can continue to function. It is also not clear why if the government has the resources, or plans to have the resources, to pay the insurance companies, why these funds could not be used to strengthen existing systems, and to better equip them to function or to ensure the reliable presence at all times of trained health human resources in public sector facilities.

Health human resources

The availability of well-trained and suitably motivated human resources remains one of the most challenging issues in public health in India. The requirement is huge, whether of doctors with a first degree, super specialists or doctors with post-graduate qualifications, nurses, allied health professionals and public health workers. Each of these categories is a crisis situation in itself.

As per the most recent information, the Medical Council of India, of which more anon, has approved, for the award of MBBS, the first degree, 80 312 seats every year of which 42 222 or slightly over 50% are in government colleges, the remainder being in private colleges. Everything to do with the establishment of medical colleges, and the conduct of the Medical Council of India, needs careful examination. The Council itself has recently been abolished with an interim body holding charge till the National Medical Commission takes office. Relevant legislation, the National Medical Commission Act of 2019, has been approved by Parliament. It is much too early to say how this reform will play out. ‘Whether this leaner avatar of the MCI in the form of the NMC will be transparent, impartial, free of corruption and improve efficiency remains to be seen’. 13

Clearly, a very large number of medical graduates are being produced every year. It is unclear how many of them are actually available for public service. It is also the case that there is a very wide variation in the quality of these graduates. Those leaving government medical colleges are generally regarded to have been better trained. While there are outstanding institutions of medical education in the private sector such as the Christian Medical College in Vellore, many of them do not have the same reputation. They survive on the strength of high fee structures, a feature that does not appear to be deterrent given the very high status given to doctors in India. The fact is, however, that a student graduating from a private college, howsoever well or badly trained, is not going to be available for public service if she is to repay the debt that she has incurred in acquiring a medical education.

Issues of medical curriculum and syllabus were not given adequate attention by the Medical Council of India prior to its unlamented demise, and the same is true of nursing education. As per the most recent information available on the Nursing Council of India which for some peculiar reason has not been abolished along with the Medical Council of India and appears to continue outside the newly created National Medical Commission, there are 1630 colleges for the training of midwives, 2960 colleges for the training of staff nurses and 1703 colleges for the training of graduate nurses. The overwhelming majority of these are privately owned and run, of indeterminate quality. Not enough positions have been created by the state governments for nurses, many of whom look for employment opportunities abroad. The nursing council also has regulatory control over the training of midwives, another shamefully neglected area.

On the positive side, we must note that there is legislation currently pending, The Allied and Healthcare Professions Bill, 2018, which aims to define and regulate the conduct and training of allied health professionals, defined as an associate, technician or technologist trained to support the diagnosis and treatment of any illness, disease, injury or impairment. The Bill further lists 15 categories of professionals, with 53 specific professions, with the possibility of including new professions as they emerge in the course of time. India is strong in the drafting of legislation and we must wait and see how effective the proposed national and state councils will be in laying down and maintaining high standards of training and professional practice.

The National Medical Commission to which have referred earlier has livened the debate considerably by proposing the introduction of a Community Health Worker, the liveliness stemming from the fact that there is no clear idea of who this person will be, and how well trained and with what specific responsibility.

Public health

In identifying three big areas where both policy and programme attention is required, disease burden, financial resources and human resources, I have still followed what might be called a hospital driven approach to healthcare. How differently do we need to think if we look at a public health policy for India?

India’s leading public health specialist, also one of India’s leading cardiologists, Dr K. Srinath Reddy has recently called attention to the six key elements of a health system identified by the WHO. 14 These are healthcare infrastructure, health work force, availability of drugs and technologies, the level and use of health financing, health information systems and overall governance of health services. Dr Reddy makes the important point that these six elements do not include the role of the community in driving demand for adequate healthcare.

It is still common in India for public health to be understood as basically concerned with hygiene and sanitation, with controlling the spread of communicable disease. ‘It could however be more usefully understood as the establishment of a viable and functioning primary healthcare system serving the community which takes into its fold all matters relating to health and welfare of the public including preventive measures, appropriate nutrition and well-functioning drinking water and sanitation systems, for all members of the public and particularly for women and children, and over their life course’.

This is a description that I have created but it covers all the relevant issues: the prevention of communicable disease, the treatment of non-communicable diseases over the life course, the need for government investment, the need for qualified persons at all levels and the role of the community. I may add that all of this said in one form or the other in India’s National Health Policy issued in 2017. The policy actually says more, including an emphasis on traditional systems of medicine, and as in the case of much of India’s legislation, is more a statement of aspiration than of commitment.

All this is easier said than done. It is not necessarily only a question of resources. Nothing can be done without resources, but resources without the necessary motivation, political will and executive ability will also not deliver satisfactory health outcomes.

I should also call attention to remarkable civil society interventions which in their motivation and work on the ground reflect the best elements of what I have defined as a public health policy. I think here of Dr Yogesh Jain and his colleagues at the Jan Swasthya Sahyog, in Chhattisgarh, at the heart of India. The JSS runs a hospital which provides a very high quality of care to a large and vulnerable population. I am grateful to Dr Jain for always calling my attention to what he describes as the diseases of the very poor. I think also of Dr Vandana Gopikumar and her colleagues at The Banyan in Chennai, an organization that has worked for 25 years now with homeless women with mental illness. In India, to be female, poor and sick is to be very vulnerable indeed and it is in the work of The Banyan that one sees a combination of professional excellence and compassionate imagination. I must also mention two institutions for children with disability, the Latika Roy Foundation in Dehradun run by the remarkable Jo Chopra and Vidyasagar in Chennai set up by Poonam Natarajan. I must also mention my friend Dr M.R. Rajagopal of Pallium India in Thiruvananthapuram, an organization devoted to establishing palliative care services.

These institutions and many more that I have not mentioned are marked in many ways but most importantly by the human and ethical quality of the individuals behind them. And while this gives these institutions their distinction, it also makes us ask the question of what one may expect from institutions which are not guided by a hugely charismatic figure. Government does not believe in charisma. Yet, it is government’s responsibility to establish fund and manage healthcare institutions. The best examples we have in India are in the non-profit sector. Where and how are we going to bring about a union?

India’s experience in tackling the AIDS epidemic stands as a lesson in how appropriate health policy and programmes can be framed in response to medical evidence, and how community involvement can significantly impact on the efficacy of health investments. My distinguished friend Sujatha Rao in her book ‘Do We Care?’ makes the point that India showed the capacity to respond to a situation which require not only clinical intervention but also changes in the societal attitudes. 15 For possibly, the first time issues of sexuality and sexual orientation were brought into the public discourse, with a recognition of the fact that behavioural change needed to drive India’s response to controlling the epidemic. India’s national AIDS control programmes will always be remembered for their pioneering efforts. Since 2014, ostensibly because the prevalence of AIDS in India has reduced, and also because the government of the day believed that abstinence was a more appropriate response to sexually transmitted diseases, public investment in AIDS control has declined. This is a worrying situation.

Public health is about social justice. The SDGs recognize this, and in their different areas, they target inequality. But it is also true that even where substantial progress has been made towards achieving the SDGs, gaps between countries and between communities within countries continue to rise enormously. 16

The distinguished psychiatrist and public health practitioner Vikram Patel has urged, ‘Inequality corrodes the fabric of a society that is crucial for all people to feel they belong to it and have a stake in a shared future. Social scientists refer to this connectedness as social capital. It acts as an invisible glue that binds us all together, both rich and poor, through good times and bad. It is this communion of hearts and minds which promotes individual, and ultimately, societal well-being. In short, inequality destroys the soul of nations, of societies, of communities and, ultimately, of every individual’s well-being’. 17

And when governments aim at making quality health care accessible and affordable, when they strive, in the words of Alma Ata, for ‘the provision of adequate health and social measures’, they work towards removing inequalities. That is the core of good governance. These noble thoughts have been reiterated in the UN General Assembly’s High Level Resolution of 23 September 2019.

Everything lies with national governments, and in the context of today’s address, India’s government and its ability to show leadership and ownership in establishing effective health governance, to promote access to safe, effective, quality and affordable essential medicines and vaccines, to invest adequate sustainable resources, to invest in the education, recruitment and retention of a fit-for-purpose and responsive public health workforce and to address the social, environmental and economic determinants of health and health inequity. These are monumental challenges and of great importance to all who care for the future of India.

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Comparative Health Policy Library

India | summary.

  • Population: 1.38 billion
  • Housing: 33% Urban, 67% Rural

Health & Health system

Health indicators & demographics.

  • Fertility Rate: 2.2 live births per woman  
  • Life Expectancy (Female, Male): 72, 69  
  • Infant Mortality Rate: 26.6  deaths per 1,000 live births  
  • Child Mortality Rate: 32.9 per 1,000 live births
  • Maternal Mortality Rate: 113 deaths per 100,000 live births  
  • Prevalence of Obesity: 4% 
  • Indo-Aryan: 72% 
  • Dravidian (South Indian): 25% 
  • 0-14 years:  27%
  • 15-24 years:  17.8%  
  • 25-54 years:  41.2%  
  • 55-64 years:  7.6%  
  • 65 years and over:  6.4% 

1 The World Bank. India&nbsp;. Data. https://data.worldbank.org/country/india . 

2 The World Bank. (2017). Current health expenditure (% of GDP). Data. https://data.worldbank.org/indicator/SH.XPD.CHEX.GD.ZS . 

3 India Population 2020 (Live). India Population 2020 (Demographics, Maps, Graphs). (2020). https://worldpopulationreview.com/countries/india-population . 

4 Mushtaq, M. (2009). Public health in British India: A brief account of the history of medical services and disease prevention in colonial India. Indian Journal of Community Medicine, 34(1), 6–14. https://doi.org/10.4103/0970-0218.45369  

5 Mushtaq, M. (2009). Public health in British India: A brief account of the history of medical services and disease prevention in colonial India. Indian Journal of Community Medicine, 34(1), 6–14. https://doi.org/10.4103/0970-0218.45369  

6 Healthcare System in India. International Student Insurance. https://www.internationalstudentinsurance.com/india-student-insurance/he... . 

7 Tabish, S. A. Health Planning: Past, Present &amp; Future. In Hospital &amp; Health Services Administration: Principles &amp; Practice. essay. https://www.researchgate.net/publication/290447383_Historical_Developmen... . 

8 OVERVIEW OF INDIAN HEALING TRADITIONS: History and Science of Indian Systems of Knowledge. OVERVIEW OF INDIAN HEALING TRADITIONS | History and Science of Indian Systems of Knowledge. https://www.ncbs.res.in/HistoryScienceSociety/content/overview-indian-he... . 

9 Ranjan, A. (2018, August 17). Healthcare System in Pre and Post Independence India. Medlife Blog: Health and Wellness Tips. https://www.medlife.com/blog/healthcare-system-pre-post-independence-india/ . 

10 Alam, M., &amp; Allchin, F. R. India. In Encyclopedia Britannica. essay. https://www.britannica.com/place/India/Health-and-welfare . 

11 Tikkanen, R., Osborn, R., Mossialos, E., Djordjevic, A., &amp; Wharton, G. A. (2020, June 5). India. Commonwealth Fund. https://www.commonwealthfund.org/international-health-policy-center/coun... . 

12 Ehrenfeld , T. (2018, September 25). Comparing the Healthcare Systems in India and the United States. Healthline. https://www.healthline.com/health-news/comparing-healthcare-systems-indi... . 

13 Brand India. IBEF. (2020, September 6). https://www.ibef.org/industry/healthcare-india.aspx . 

14 Harvard T.H. Chan School of Public Health. (2018, March 7). Improving Health in India. India Research Center. https://www.hsph.harvard.edu/india-center/improving-health-in-india/ . 

15 Healthcare System in India. International Student Insurance. https://www.internationalstudentinsurance.com/india-student-insurance/he... . 

16 Geography Now! India. (2017). YouTube. https://www.youtube.com/watch?v=vEy6tcU6eLU . 

17 India Population (LIVE). Worldometer. (2020). https://www.worldometers.info/world-population/india-population/ . 

18 India Age structure. India Age structure - Demographics. (2020). https://www.indexmundi.com/india/age_structure.html . 

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  • Society in Transition: Impacts of the Pandemic

The COVID-19 pandemic in India caused considerable suffering, along with economic and social disruption. Till October 2021, 34.3 million people were infected by COVID-19, and an estimated 0.45 million people died. One of the defining features of the pandemic was a public reckoning of the state of the health system. Was the healthcare system in India capable of responding to a large-scale pandemic? What were the economic costs of the lockdowns imposed to control the pandemic? And what is the direction of public healthcare in India?

The Indian Healthcare System

The good news is public health expenditure in India has increased. Revised estimates for 2020-21 place the share of overall spending on health at 1.8% of GDP. The SDG India Index Report (2019-20) by NITI Aayog reports that India aims to increase health expenditure to 2.5% of GDP by 2025. Furthermore, important health schemes such as Ayushman Bharat , launched by the National Health Policy 2017, aim to widen tertiary health coverage.

While these measures are promising, India lags in public health investments and infrastructure, both in contrast to its international peers as well as compared to its own aspirations. Current health expenditure in India is lower than the world average of 9.8% of GDP as of 2018. According to World Bank data, current health expenditure (% of GDP) was 9.51% for Brazil, 5.32% for Russia, 4.12% for Turkey and 2.18% for Indonesia in 2018. India’s federal structure implies that both the centre and state governments spend on healthcare. However, state health expenditure in India is highly divergent, ranging from 3.4% to 12.66% of state budgets, as of 2020-21.

What is more concerning is the health infrastructure investments in India – which fall short of the demands of its large population, and the expenditure levels as well. Total number of government hospital beds per thousand vary widely across states. In 2019, for instance, Karnataka and Kerala had 67 and 61 government hospital beds per thousand, respectively, while states like Punjab and Uttar Pradesh had 22 and 11 government hospital beds per thousand people respectively. Indeed, the covid facility camps and beds may have increased during the pandemic (data not yet available on this), yet disparity in health infrastructure across states is a standing issue.

Economic Costs of the First Lockdown

During the first wave of infections in India in March-May 2020, the Government of India implemented the “world’s strictest lockdown” ( Hale et al. 2020 ). This lockdown severely disrupted business activity and mobility, with millions of migrants traveling back to their villages as opportunities for work in the cities dried up.

The rationale behind implementing this lockdown was to curtail the spread of Covid-19 and to reduce the consequent burden on the healthcare system to save lives. The government hoped that the lockdown would allow for a quicker resumption of normal economic activity over time. However, the trade-off from the lockdowns was short-run reductions in economic activity. In contrast to wealthier countries, the lockdown potentially affected the Indian economy more as per capita incomes were lower; remote working was less prevalent; the extent of digitisation was lower, and social protection was weaker.

What was the economic cost of this lockdown? One perspective is that Gross Domestic Product (GDP) contracted by 24.4% in the second quarter of 2020. However, this headline number conflates both lockdown effects, as well as potentially self-imposed restrictions as citizens restrict their own activities due to the spread of Covid-19 infections. To isolate the impact of government-imposed restrictions (separately from other factors), Beyer, Jain and Sinha 2020 examined the economic implications of a graded ‘unlock’ in May and June 2020, when the central government decided to vary containment rules across districts in the country).

The Impact of Zonal Containment on Economic Activity

The Government of India announced a comprehensive nationwide lockdown on 25 March 2020, which was implemented uniformly across all states and districts. During this phase, nearly all offices, commercial and private establishments, industrial units, as well as public services were closed. Most transportation services – including international and domestic flights, railways, and roadways – were suspended. Hospitality services and educational institutions were shut. This nationwide lockdown lasted until 3 May 2020.

To facilitate a gradual resumption of economic activity, the government announced in May 2020 a differentiated unlock of districts, with some districts retaining strict restrictions, some with intermediate measures, and the remaining districts returning to “business as usual”. The authors of this article contrasted how these districts fared on a range of outcomes – individual mobility (measured by location tracking on cell phones), economic activity (measured by satellites from outer space), and household consumption and income (measured by household surveys).

What were the findings? First, phone location data corroborated that the restrictions were indeed effective in reducing mobility, as the government mandated. The main finding is that the economic recovery was lower by 9.3% in districts with the maximum restrictions relative to districts with minimal restrictions. The recovery was 1.6% lower in districts with intermediate restrictions compared to districts with minimal restrictions. These results are not driven by India’s large metropolitan cities and hold even when they are excluded from the analysis. Some districts were more impacted by the restrictions than others. More developed districts with above-median population density, share of employment in services, credit per capita, and average age, experienced larger impacts.

Households reported both lower income as well as reduced consumption as a consequence of the lockdowns, worrying for the long run if this impacts human capital investments in nutrition, health, and education.

India suffered a lot less economically during the second wave of the pandemic due to imposition of micro-containment zones, in contrast to nationwide lockdown during the first wave. Policymakers can continue to follow similar approaches and maintain preventive measures and protocols which could enable least disruption to economic activity, trade, and travel even as threats of further variants emerge.

public health system in india essay

Policy Trade-offs

Could greater public health expenditures insure against the need for large scale lockdowns in future health emergencies? For policymakers, GDP decline estimates offer a useful benchmark to contrast with public health expenditures.

India’s economic policymakers well understand the value of increased investments in healthcare. During the pandemic, Indian public health expenditure rose from 1.5% of GDP to 1.8% of GDP. The PM Ayushman Bharat Health Infrastructure Mission scheme aims to increase infrastructure, with financing from the central government. Furthermore, the private sector played a major role during the pandemic, from the development and manufacture of vaccines, to diagnosis of COVID-19 infections and vaccination. To prevent high prices, the government regulated private sector with extensive price controls. Whether this expansion of private sector activities sustains (both in COVID-19 related and other healthcare needs) is an open question.

The way forward should involve building public consensus on the importance of healthcare investments and recognizing the potential economic gains from greater investments.

Disclaimer: The views expressed in the article are those of Dr.  Sinha and Prof.  Jain and not the Reserve Bank of India. The usual disclaimer applies.

Further Reading:

Beyer, R., T. Jain and. S Sinha (2020), ‘ Lights out? COVID-19 containment policies and economic activity ’, World Bank Policy Research Working Paper 9485.

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  • v.43(3); Jul-Sep 2018

Challenges to Healthcare in India - The Five A's

Arvind kasthuri.

Department of Community Health, St John's Medical College, Bengaluru, Karnataka, India

The Indian healthcare scenario presents a spectrum of contrasting landscapes. At one end of the spectrum are the glitzy steel and glass structures delivering high tech medicare to the well-heeled, mostly urban Indian. At the other end are the ramshackle outposts in the remote reaches of the “other India” trying desperately to live up to their identity as health subcenters, waiting to be transformed to shrines of health and wellness, a story which we will wait to see unfold. With the rapid pace of change currently being witnessed, this spectrum is likely to widen further, presenting even more complexity in the future.

Our country began with a glorious tradition of public health, as seen in the references to the descriptions of the Indus valley civilization (5500–1300 BCE) which mention “Arogya” as reflecting “holistic well-being.”[ 1 ] The Chinese traveler Fa-Hien (tr.AD 399–414) takes this further, commenting on the excellent facilities for curative care at the time.[ 2 ] Today, we are a country of 1,296,667,068 people (estimated as of this writing) who present an enormous diversity, and therefore, an enormous challenge to the healthcare delivery system.[ 3 ] This brings into sharp focus the WHO theme of 2018, which calls for “Universal Health Coverage-Everyone, Everywhere.”

What are the challenges in delivering healthcare to the “everyone” which must include the socially disadvantaged, the economically challenged, and the systemically marginalized? What keeps us from reaching the “everywhere,” which must include the remote areas in our Himalayan region for instance, where until recently, essentials were airlifted by air force helicopters?.[ 4 ]

While there are many challenges, I present five “A's” for our consideration:

Why is the level of health awareness low in the Indian population? The answers may lie in low educational status, poor functional literacy, low accent on education within the healthcare system, and low priority for health in the population, among others.

What is encouraging is that efforts to enhance awareness levels have generally shown promising results. For instance, a study in Bihar and Jharkhand demonstrated improved levels of awareness and perceptions about abortion following a behavioral change intervention.[ 9 ] A review on the effectiveness of interventions on adolescent reproductive health showed a considerable increase in the awareness levels of girls with regard to knowledge of health problems, environmental health, nutritional awareness, and reproductive and child health following intervention.[ 10 ]

The message is clear – we must strive to raise awareness in those whom we work with and must encourage the younger generation to believe in the power of education for behavior change.

Physical reach is one of the basic determinants of access, defined as “ the ability to enter a healthcare facility within 5 km from the place of residence or work”[ 13 ] Using this definition, a study in India in 2012 found that in rural areas, only 37% of people were able to access IP facilities within a 5 km distance, and 68% were able to access out-patient facilities[ 14 ] Krishna and Ananthapur, in their 2012 paper, postulate that in general, the more rustic (rural) one's existence – the further one lives from towns – the greater are the odds of disease, malnourishment, weakness, and premature death.[ 15 ]

Even if a healthcare facility is physically accessible, what is the quality of care that it offers? Is that care continuously available? While the National (Rural) Health Mission has done much to improve the infrastructure in the Indian Government healthcare system, a 2012 study of six states in India revealed that many of the primary health centers (PHCs) lacked basic infrastructural facilities such as beds, wards, toilets, drinking water facility, clean labor rooms for delivery, and regular electricity.[ 14 ]

As thinkers in the disciplines of community medicine and public health, we must encourage discussion on the determinants of access to healthcare. We should identify and analyze possible barriers to access in the financial, geographic, social, and system-related domains, and do our best to get our students and peers thinking about the problem of access to good quality healthcare.

A 2011 study estimated that India has roughly 20 health workers per 10,000 population, with allopathic doctors comprising 31% of the workforce, nurses and midwives 30%, pharmacists 11%, AYUSH practitioners 9%, and others 9%.[ 16 ] This workforce is not distributed optimally, with most preferring to work in areas where infrastructure and facilities for family life and growth are higher. In general, the poorer areas of Northern and Central India have lower densities of health workers compared to the Southern states.[ 17 ]

While the private sector accounts for most of the health expenditures in the country, the state-run health sector still is the only option for much of the rural and peri-urban areas of the country. The lack of a qualified person at the point of delivery when a person has traveled a fair distance to reach is a big discouragement to the health-seeking behavior of the population. According to the rural health statistics of the Government of India (2015), about 10.4% of the sanctioned posts of auxiliary nurse midwives are vacant, which rises to 40.7% of the posts of male health workers. Twenty-seven percentage of doctor posts at PHCs were vacant, which is more than a quarter of the sanctioned posts.[ 18 ]

Considering that the private sector is the major player in healthcare service delivery, there have been many programs aiming to harness private expertise to provide public healthcare services. The latest is the new nationwide scheme proposed which accredits private providers to deliver services reimbursable by the Government. In an ideal world, this should result in the improvement of coverage levels, but does it represent a transfer of responsibility and an acknowledgment of the deficiencies of the public health system?

As trainers and educators in public health, how are we equipping our trainees to deliver a health service in the manner required, at the place where it is needed and at the time when it is essential? It is time for a policy on health human power to be articulated, which must outline measures to ensure that the last Indian is taken care of by a sensitive, trained, and competent healthcare worker.

It is common knowledge that the private sector is the dominant player in the healthcare arena in India. Almost 75% of healthcare expenditure comes from the pockets of households, and catastrophic healthcare cost is an important cause of impoverishment.[ 19 ] Added to the problem is the lack of regulation in the private sector and the consequent variation in quality and costs of services.

The public sector offers healthcare at low or no cost but is perceived as being unreliable, of indifferent quality and generally is not the first choice, unless one cannot afford private care.

The solutions to the problem of affordability of healthcare lie in local and national initiatives. Nationally, the Government expenditure on health must urgently be scaled up, from <2% currently to at least 5%–6% of the gross domestic product in the short term.[ 20 ] This will translate into the much-needed infrastructure boost in the rural and marginalized areas and hopefully to better availability of healthcare– services, infrastructure, and personnel. The much-awaited national health insurance program should be carefully rolled out, ensuring that the smallest member of the target population is enrolled and understands what exactly the scheme means to her.

Locally, a consciousness of cost needs to be built into the healthcare sector, from the smallest to the highest level. Wasteful expenditure, options which demand high spending, unnecessary use of tests, and procedures should be avoided. The average medical student is not exposed to issues of cost of care during the course. Exposing young minds to issues of economics of healthcare will hopefully bring in a realization of the enormity of the situation, and the need to address it in whatever way possible.

  • Accountability or the lack of it: Being accountable has been defined as the procedures and processes by which one party justifies and takes responsibility for its activities.[ 21 ]

In the healthcare profession, it may be argued that we are responsible for a variety of people and constituencies. We are responsible to our clients primarily in delivering the service that is their due. Our employers presume that the standard of service that is expected will be delivered. Our peers and colleagues expect a code of conduct from us that will enable the profession to grow in harmony. Our family and friends have their own expectations of us, while our government and country have an expectation of us that we will contribute to the general good. A spiritual or religious dimension may also be considered, where we are accountable to the principles of our faith.

In the turbulent times that we live in, the relationships with all the constituents listed above have come under stress, with the client-provider axis being the most prominently affected. While unreasonable expectations may be at the bottom of much of the stress, it is time for the profession to recognize that the first step on the way forward is the recognition of the problem and its possible underlying causes. Ethics in healthcare should be a hotly discussed issue, within the profession, rather than outside it.

Communication is a key skill to be inculcated among the young professionals who will be the leaders of the profession tomorrow. As leaders in community medicine and public health, we may be the best placed to put this high up in the list of skills to be imparted. A good communicator is better placed to deal with the pressures of the relationships with client, employer, peer, colleague, family, friend, and government.

The five as presented above present challenges to the health of the public in our glorious country. As we get ready to face a future which is full of possibility and uncertainty in equal measure, let us recognize these and other challenges and prepare to meet them, remembering that the fight against ill health is the fight against all that is harmful to humanity.

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Recently ,it has been observed  that Public health is a separate profession requiring a specific set of competencies.

About Public health System

  • A trained public health workforce ensures that people receive holistic health care, of preventive and promotive services (largely in the domain of public health) as well as curative and diagnostic services (as part of medical care). 
  • These competencies are also critical for monitoring and evaluating programmes, conducting surveillance, and interpreting data and routine reporting.
  • Public health requires social mobilisation at the grassroots level by understanding community needs, community organisation, etc.This requires grounding in social and behavioural sciences. 
  •  This includes implementing and managing health programmes, addressing human resource issues, supply and logistical issues, etc.
  • It includes micro planning of programme delivery, team building, leadership as well as financial management to some extent. 
  • This requires clear enunciation of the need, analysis of alternative set of actions and the cost of implementation or non-implementation. Good communication and negotiation skills are critical to perform this function. The related subjects are health policy, health economics, health advocacy and global health. 
  • Application : These four functionalities can be applied to any specific or general problem such as environment or nutrition or infectious disease and can be considered to be similar to super-specialisation in other medical fields.Pandemic management required all the four competencies in equal measure.
  • The first is exclusively reserved for doctors (the extra year is devoted to provision of medical care), while the second is open to non-medical persons as well. 
  • In addition to classroom teaching, public health trainees are posted in communities and at different levels of the health system. 

Major Issues 

  • All those who work for the State or Central government are public sector health workers, but they are not doing public health. Providing medical care at a primary health centre does not make the person a public health professional.
  • During the pandemic, many doctors with no training in public health provided expert advice on public health issues. This is because it is felt that public health does not require specific competencies.
  • They do not become public health professionals as they may not have the necessary skills. 
  • India lacks affordable health care services for the marginalised sections.
  • Lack of robust public health infrastructures like hospitals, primary health centres.
  • Lack of number of Doctors and Specialists as per the population of the country.
  • Lack of awareness among the people

Suggestions 

  • It is critical that health professionals, the government, and the public recognise public health as a specific set of competencies and give it the importance that it deserves. 
  • The Health Ministry’s recent proposal for the creation of cadres for public health professionals and health management at the State, district and block levels is a welcome step. 
  • However, it is not sufficient. There is also a need to look at the quality of public health training being provided. Only this will attract the best and the brightest people into this discipline, which is very important for the nation’s health. This is one lesson that we should learn from the pandemic.
  • There is an urgency to focus on all the three levels of p rimary, secondary and tertiary healthcare , it is imperative that the government look towards improving primary health care as a public good.
  • There is a need for an increase in expenditure on health so that India can improve existing facilities as well as add more of them.

RELATED ARTICLES MORE FROM AUTHOR

Changing the growth paradigm, the big diversity blindspot in health policy, role of modern technologies in india’s affordable housing, daily current affairs 24-02-2024.

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What is the current Scenario of the Health Care Sector of India? What are the major concerns? How to use India’s huge potential in the health sector to rectify the problems? Read further to know more about  Health Sector in India.

The Constitution considers the “Right to Life” to be essential, and the government is required to protect everyone’s “ Right to Health .”

The healthcare industry in India includes hospitals, medical tourism, health insurance, medical equipment, telemedicine, outsourcing, clinical trials, and medical gadgets.

The public and private sectors make up the two main components of India’s healthcare delivery system.

Table of Contents

The Scenario of the Health Care Sector in India

Let us look at an overview of the current healthcare sector in India

Health Infrastructure

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 majority of secondary, tertiary, and quaternary care facilities are run by the private sector.

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India has 1.3 beds per 1,000 people, 0.5 pharmacists per 1,000 people, and 0.8 physicians per 1,000 people, which are all less than half the global average.

Quality of Health Care Services

India is ranked 145 th out of 180 nations in terms of the accessibility and quality of healthcare, according to the Economic Survey (Global Burden of Disease Study 2016)

To achieve an ideal doctor-to-population ratio of 1:1000 by 2030, India will require an additional 2 million doctors.

Disease Burden

Despite having 17% of the world’s population, India bears a disproportionately large portion of the global disease burden (20%).

India’s public healthcare spending was 2.1% of GDP in 2021–2022, up from 1.8% in 2020–2021, according to the  Economic Survey of 2022 .

Challenges in Health Sector

Although India’s healthcare sector has made significant progress in terms of health indicators, it still has some serious flaws in service delivery due to inadequate healthcare infrastructure.

Inadequate Accessibility

Insufficient access to basic healthcare services to all, due to a shortage of medical professionals, a lack of quality assurance, and insufficient health spending.

Insufficient Funding

One of the major concerns is the administration’s lack of financial resources and insufficient funding for research and development.

India’s government will only spend 2.1% of its GDP on healthcare in 2021–22, compared to 10% for Japan, Canada, and France.

No focus on Preventive Care

Despite being shown to be quite beneficial in alleviating a variety of difficulties for patients in terms of unhappiness and financial losses, preventive care is undervalued in India.

Shortage of Medical Workforce

Doctors, nurses, and other healthcare professionals are in short supply in India. According to a minister’s study presented in Parliament, India is short 600,000 doctors.

Lack of Infrastructure

Private hospitals are expensive, whereas Government hospitals are either inadequate or lacking in basic facilities for the Indian population.

Optimal Insurance

The concept of health insurance is still unclear in India, and the market is underdeveloped.

Policymaking

Policymaking is undeniably important in providing effective and efficient healthcare services. The problem in India is one of supply rather than demand, and policy can help.

Potential in Health Care Sector in India

Despite the challenges, there were opportunities. The Indian healthcare system has a unique opportunity to advance while taking stock of the past and getting ready for the future while keeping the welfare of its people in mind.

Strong Demand

According to Aspire Circle, the Indian healthcare sector is expected to reach $744 billion by 2030, driven by greater access to insurance, better health awareness, lifestyle diseases, and rising income.

Innovative Technologies

As part of the National Digital Health Mission ( NDHM ), the digital Health ID will be introduced, which will save patient data. It would aid in effective policymaking, and private firms would benefit from a competitive advantage in the market introduction of innovative technology.

With the advent of information technology and big data, it would be simple for private players to spend strategically.

Rising Manpower

The abundance of highly qualified medical personnel in India is a competitive advantage. With 4.7 million workers as of 2021, the Indian healthcare industry is one of the country’s largest employers.

From 0.83 million in 2010 to 1.3 million in November 2021, the number of allopathic doctors with recognised medical qualifications (under the I.M.C Act) registered with state medical councils/national medical council

Cost Competent

India’s costs are competitive with those of its countries in Asia and the West. Surgery in India costs roughly a tenth of what it does in the US or Western Europe.

Attractive Opportunities

Two vaccines Bharat Biotech’s Covaxin and Oxford-Covishield, AstraZeneca’s both made by SII were critical in protecting the Indian population from COVID-19.

India has emerged as a hub for R&D activities for international players due to its relatively low cost of clinical research.

With the help of the government and private stakeholders, a climate conducive to start-ups and entrepreneurship can be created in this field.

Hub of Medical Tourism

India is already one of the world’s most popular medical tourism destinations, and this industry has significant potential in the coming years.

The low cost of medical services has resulted in a rise in the country’s medical tourism, attracting patients from across the world.

India possesses all the necessary factors for this industry to grow rapidly, including a sizable population, a strong pharmaceutical and medical supply chain, more than 750 million smartphone users, the third-largest global start-up pool with simple access to Venture Capital funding, and innovative tech entrepreneurs looking to address global healthcare issues.

Measures Required in the Health Sector

These are the following major measures for improving the health sector in India:

  • Strengthening the Infrastructure: Because of India’s large population, there is an urgent need to improve the infrastructure of public hospitals, which are overburdened.
  • Encourage Private Hospitals: The government should support private hospitals because they contribute significantly to the Indian Health sector. The challenges are severe and cannot be addressed solely by the government, the private sector must also participate with Government for the public good.
  • Increased efficiency: More medical personnel must be hired in order to improve the sector’s capabilities and efficiency.
  • Utilization of Technology: Technology must be used to connect the dots in the health system. Medical devices in hospitals and clinics, mobile health apps, wearables, and sensors are just a few examples of technology that should be considered.
  • Improving Mental Health Care Services: Increasing financing for mental health services, educating healthcare professionals on how to effectively treat mental health issues, and lowering the stigma attached to mental illness are all part of improving mental health services.
  • Addressing the Root Causes of Health Disparities: To address the social determinants of health and reduce overall health inequities, the healthcare system should collaborate with other sectors, such as education, housing, and sanitation.
  • Sustainable Health governance: To promote more effective and efficient healthcare services, sustainable health governance may involve implementing better management systems, bolstering healthcare regulatory organisations, and developing independent oversight mechanisms.
  • Make Public Awareness: People should be made aware of the value of early detection and prevention. It would also help them save money on out-of-pocket expenses.
  • One Health Approach: The need for communal health programmes that address a healthy environment, healthy animals, and healthy people is urgent. This is known as the “one health approach,” and it aims to address these connections between human and animal health.

Also read: Medical Device Sector in India

Major Steps Taken by the Government

Despite the fact that health is a state issue, the Central Government assists state governments in providing health services through a variety of primary, secondary, and tertiary care systems.

In the Union Budget 2023-24:

  • Rs. 89,155 crore was allocated to the health sector, an increase of over 13% from the previous budget.
  • Allocated Rs. 6835 crore for establishing 22 new  All India Institute of Medical Sciences (AIIMS).
  • Additionally, the National Health Mission’s budget allocation increased from Rs. 28,974 crore in the preceding years to Rs. 29,085 crore in the current 2023–24 budget.
  • Budgetary support for the National Digital Health Mission increased from the previous year’s Rs. 140 crore to the current Rs. 341 crore.
  • The funds allotted for autonomous bodies were also scaled up, going from Rs. 10,348 crore in the previous budgeted allocation to Rs. 17,322 crore at the moment.

In order to promote medical tourism in the country, the government of India is extending the e-medical visa facility to the citizens of 156 countries.

Prime Minister Mr. Narendra Modi introduced the Ayushman Bharat Digital Mission in September 2021. The endeavour will link the digital health solutions of hospitals across the country. Every citizen will now have access to a digital health ID, and their medical records will be safeguarded online.

In July 2021, the Ministry of Tourism established the ‘National Medical & Wellness Tourism Board’ to promote medical and wellness tourism in India.

In July 2021, the Union Cabinet approved the continuation of the National Ayush Mission , responsible for the development of traditional medicines in India, as a centrally sponsored scheme until 2026.

In July 2021, the Union Cabinet approved the MoU between India and Denmark on cooperation in health and medicine . The agreement will focus on joint initiatives and technology development in the health sector, with the aim of improving public health status of the population of both countries.

India is a land full of opportunities for Health Care and Services. Along with being one of the top places for high-end diagnostic services, the nation has made significant capital investments in advanced diagnostic facilities to serve a larger proportion of the population.

Future demand for healthcare services is anticipated to increase due to factors such as advancing income levels, an ageing population, rising health awareness, and shifting attitudes toward preventative healthcare.

A comprehensive strategy is required to address issues in India’s healthcare industry. This necessitates active collaboration between all stakeholders, including the public, private, and individual sectors.

In 2023, India’s approach to social determinants of health (SDH) could be consolidated and expanded. As a major economic pillar, India must now maintain its existing interest in strategic health policy.

Read:  Climate Resilient Health Systems

Article written by: Aryadevi E S

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public health system in india essay

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Essay on Healthcare in India

Students are often asked to write an essay on Healthcare in India in their schools and colleges. And if you’re also looking for the same, we have created 100-word, 250-word, and 500-word essays on the topic.

Let’s take a look…

100 Words Essay on Healthcare in India

Introduction.

Healthcare in India is a critical sector. It includes public and private hospitals, clinics, and other medical facilities.

Public Healthcare

The government provides public healthcare. It’s often free or low-cost, making it accessible to many people.

Private Healthcare

Private healthcare, on the other hand, is usually more expensive. However, it tends to have better facilities and shorter wait times.

India faces challenges in healthcare, like inadequate facilities in rural areas and a shortage of trained medical professionals.

Despite these challenges, India is striving to improve its healthcare system for everyone.

250 Words Essay on Healthcare in India

Healthcare in India is a multifaceted system, encompassing public and private sectors, traditional and modern medicine, and urban and rural disparities. This essay explores the current state of healthcare in India, its challenges, and potential solutions.

Current State of Healthcare

India’s healthcare sector has made significant strides, with increased life expectancy and decreased infant mortality. However, it is riddled with disparities. While urban areas enjoy better healthcare facilities, rural regions grapple with inadequate infrastructure and lack of trained medical personnel.

The challenges are manifold. Accessibility and affordability remain major concerns. A large portion of the population lacks access to quality healthcare, while high out-of-pocket expenses push many into poverty. Furthermore, there is a significant shortage of healthcare professionals, particularly in rural areas.

Public-Private Partnership

A public-private partnership (PPP) is seen as a viable solution. The private sector’s resources and efficiency can supplement the public sector’s reach and affordability. However, the implementation of PPPs requires stringent regulations to prevent exploitation.

Role of Technology

Technology can bridge the urban-rural divide. Telemedicine, AI, and mobile health technologies can facilitate remote consultations, predictive diagnostics, and health monitoring, making healthcare more accessible and affordable.

While India’s healthcare system faces significant challenges, the combination of public-private partnerships and technology can pave the way for an efficient, inclusive, and affordable healthcare system. It is crucial for policymakers, healthcare providers, and technology companies to work together towards this common goal.

500 Words Essay on Healthcare in India

India’s healthcare sector is a study in contrasts, presenting a complex tapestry of cutting-edge advancements and systemic challenges. With an expansive population and diverse health needs, the healthcare system in India is a critical component of the nation’s development agenda.

The Landscape of Indian Healthcare

India’s healthcare infrastructure is a mix of public and private providers. The public system, under the aegis of the Ministry of Health and Family Welfare, provides primary, secondary, and tertiary care. However, it suffers from inadequate funding, lack of infrastructure, and a dearth of healthcare professionals. The private sector, on the other hand, is burgeoning. It is technologically advanced, offers high-quality services, but is often criticized for being expensive and inaccessible to the poor.

Healthcare Accessibility and Affordability

Access to quality healthcare is a significant issue in India. Rural areas, in particular, face a shortage of healthcare facilities and professionals. The urban-rural divide is stark, with the majority of quality healthcare services concentrated in cities. Affordability is another concern. High out-of-pocket expenses push many into poverty every year. The situation calls for a robust health insurance framework to protect citizens from catastrophic health expenditures.

Government Initiatives

Recognizing these challenges, the Indian government has launched various initiatives. The National Health Mission aims to improve health outcomes, particularly for the rural population. The Ayushman Bharat scheme, launched in 2018, provides health insurance coverage to the underprivileged, aiming to make healthcare more affordable. These initiatives, while commendable, need effective implementation and monitoring to ensure their success.

Technological Innovations

Technological innovations have the potential to revolutionize India’s healthcare landscape. Telemedicine, artificial intelligence, and digital health records can address the issues of accessibility and affordability. Telemedicine can bridge the urban-rural divide by providing remote consultations. AI can assist in disease prediction and management, while digital health records can streamline patient data, improving efficiency and patient care.

Challenges and Future Prospects

Despite these advancements, India’s healthcare system faces significant challenges. The COVID-19 pandemic has exposed the fragility of the healthcare infrastructure, with hospitals overwhelmed and resources stretched thin. India also grapples with a dual disease burden – communicable diseases like tuberculosis and non-communicable diseases like diabetes and heart disease.

The future of healthcare in India lies in adopting a holistic approach. This includes increasing public health expenditure, strengthening primary healthcare, improving health literacy, and leveraging technology.

India’s healthcare sector, while fraught with challenges, is teeming with potential. With the right mix of policy interventions, technology adoption, and a focus on equitable access, India can transform its healthcare landscape, ensuring a healthier future for its citizens. The journey is long and arduous, but with concerted efforts, a robust and inclusive healthcare system is achievable.

That’s it! I hope the essay helped you.

If you’re looking for more, here are essays on other interesting topics:

  • Essay on Handloom and Indian Legacy
  • Essay on Growth of Banking Sector in India
  • Essay on Greatness of India

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Essay: Public Health System in India

The India’s government has been blamed because of its public health system (Gupta, Kumra, & Maitra, 2005). It is said to be so ineffective such that most of the people prefer visiting private doctors. Studies indicate that the problem does not lie with the infrastructure, which is considered highly advanced, but it lies with the staffing.

The public health is understaffed making it hard for the government to fulfill its mandate to its publics of most of who are living below the poverty line. They cannot afford to attend private services.

Agarwal (2008) associates the prevailing problem with poor vaccine coverage, and in line with this, the government of India should ensure that its health system is well equipped with staff so that they can reach the growing number of children effectively. Otherwise, the rights of children and women will still remain at stake.

These are just model papers; Please place an order for essays, term papers, research papers, thesis, dissertations, article critique, coursework, case studies and book reports.

public health system in india essay

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  1. Public Health System In India

    The current pandemic reiterates the importance of Public Health systems. Thus, there is a need to address the constraints and revamp of the public health system in India. Associated Challenges With Public Health Systems in India. Lack of Primary Healthcare Services: The existing public primary health care model in the country is limited in scope.

  2. India health system review

    India has made significant improvements in the health outcomes of its people. Life expectancy at birth increased to 69.6 years in 2020, from expected 47.7years in 1970. MMR declined from 301 to 130 per 100 000 live births between 2003 and 2014-16, and IMR declined from 68 in the year 2000 to 24 per 1000 live births in 2016.

  3. Public Health Challenges in India: Seizing the Opportunities

    The Health Challenges. In health sector, India has made enormous strides over the past decades. The life expectancy has crossed 67 years, infant and under-five mortality rates are declining as is the rate of disease incidence. Many diseases, such as polio, guinea worm disease, yaws, and tetanus, have been eradicated.

  4. The Transformation of The Indian Healthcare System

    The Indian healthcare system is a diverse and complex network of public and private sectors that provide a wide range of medical services to India's 1.4 billion inhabitants. Despite undergoing significant changes over the years, the system continues to face multiple challenges. ... Over 217 thousand public health facilities were reported in ...

  5. Public health priorities for India

    Indian states are in different phases of epidemiological transition, resulting in large variations in disease burden across the states.1 However, the public health priorities across the country remain similar. Addressing the availability of relevant and robust data for meaningful planning of programmes and policies is a gap that needs urgent consideration to improve population health and the ...

  6. Improving Health in India

    According to the World Bank, infant mortality in India fell from 66 to 38 per 1,000 live births from 2000 to 2015. Life expectancy at birth has increased from 63 to 68 years, and the maternal mortality ratio has fallen from 374 to 174 per 100,000 live births over the same period. India also has dynamic pharmaceutical and biotechnology ...

  7. Strengthening public healthcare systems in India; Learning lessons in

    Keywords: COVID 19, India, lessons. COVID-19 pandemic globally has emphasized the need for strengthening public health care systems. Earlier in 2016, Ebola outbreak raised concerns about the poor preparedness of health systems globally. [ 1, 2] System strengthening is essential as trial times that are visible during pandemics and epidemics ...

  8. Public health system in India

    The public healthcare system in India evolved due to a number of influences since 1947, including British influence from the colonial period. The need for an efficient and effective public health system in India is large. Public health system across nations is a conglomeration of all organized activities that prevent disease, prolong life and promote health and efficiency of its people.

  9. India Health System Review

    India Health System Review Health Systems in Transition Vol. 11 No. 1 2022 Written by: Sakthivel Selvaraj, Public Health Foundation of India, Delhi, India Anup K Karan, Indian Institute of Public Health, Delhi, India Swati Srivastava, Medical Faculty and University Hospital, Heidelberg University, Germany Nandita Bhan, Center on Gender Equity and Health, India

  10. Strengthening public healthcare systems in India; Learning l ...

    COVID-19 pandemic globally has emphasized the need for strengthening public health care systems. Earlier in 2016, Ebola outbreak raised concerns about the poor preparedness of health systems globally.[1 2] System strengthening is essential as trial times that are visible during pandemics and epidemics leave no time for preparedness.Universal Health Coverage (UHC) is to ensure that everyone ...

  11. India Health Systems Reform Project

    The India Health Systems Reform Project is motivated by the goal of advancing health system reforms in India to provide equitable access to good quality of care and financial risk protection for its citizens. The Project adopts a three-pronged strategy encompassing (1) high quality research to diagnose health systems and propose potential ...

  12. Issues in Public Health in India

    India's leading public health specialist, also one of India's leading cardiologists, Dr K. Srinath Reddy has recently called attention to the six key elements of a health system identified by the WHO. 14 These are healthcare infrastructure, health work force, availability of drugs and technologies, the level and use of health financing ...

  13. INDIA

    OVERVIEW | HISTORY | HEALTH & HEALTH SYSTEM | HEALTH INDICATORS & DEMOGRAPHICSOVERVIEW GDP: 2.875 Trillion USD1 Health Expenditure (% of GDP): 3.53%2 Populace3 Population: 1.38 billion Housing: 33% Urban, 67% RuralhistoryWestern medicine has existed in India since the 1600s starting with early Portuguese influence5 but it wasn't until 1664 that the French established the first hospital ...

  14. (PDF) The Public Health System in India

    William Stonesb. This paper examines the extent of inequalities in human resource provision at India's Heath Sub-Centres (HSC) - first level of service provision in the public health system ...

  15. COVID-19 and Public Health in India

    The COVID-19 pandemic in India caused considerable suffering, along with economic and social disruption. Till October 2021, 34.3 million people were infected by COVID-19, and an estimated 0.45 million people died. One of the defining features of the pandemic was a public reckoning of the state of the health system.

  16. Quality Of Health Care In India: Challenges ...

    India's health care sector provides a wide range of quality of care, from globally acclaimed hospitals to facilities that deliver care of unacceptably low quality. Efforts to improve the quality ...

  17. Challenges to Healthcare in India

    As leaders in community medicine and public health, we may be the best placed to put this high up in the list of skills to be imparted. A good communicator is better placed to deal with the pressures of the relationships with client, employer, peer, colleague, family, friend, and government. The five as presented above present challenges to the ...

  18. India Inequality Report 2021: India's Unequal Healthcare Story

    In the 2021-22 union budget, a year following a pandemic, the Ministry of Health and Family Welfare (MoHFW) was allocated a total of INR 76,901 crore, a decline of 9.8 percent from INR 85,250 crore from the revised estimates of 2020-21. Higher public health allocations have shown positive effect on health outcomes in pandemic.

  19. Public health System in India

    India's healthcare delivery system is categorised into two major components public and private. The government, i.e. public healthcare system, comprises limited secondary and tertiary care institutions in key cities and focuses on providing basic healthcare facilities in the form of primary healthcare centres (PHCs) in rural areas.

  20. Health Sector in India

    The Scenario of the Health Care Sector in India. Let us look at an overview of the current healthcare sector in India. Health Infrastructure. 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.

  21. Essay on Healthcare in India

    500 Words Essay on Healthcare in India Introduction. India's healthcare sector is a study in contrasts, presenting a complex tapestry of cutting-edge advancements and systemic challenges. With an expansive population and diverse health needs, the healthcare system in India is a critical component of the nation's development agenda.

  22. Enhance field epidemiology workforce in South-East Asia Region: WHO

    The World Health Organization and member countries in South-East Asia Region are prioritizing enhancing field epidemiology workforce as part of strengthening capacities to respond to health emergencies."One of the lessons from COVID-19 pandemic is that field epidemiology workforce is a critical component of national health security systems. Continued efforts are needed to invest in field ...

  23. Essay: Public Health System in India

    The India's government has been blamed because of its public health system (Gupta, Kumra, & Maitra, 2005). It is said to be so ineffective such that most of the people prefer visiting private doctors. Studies indicate that the problem does not lie with the infrastructure, which is considered highly advanced, but it lies with the staffing.