Strengthening Primary Healthcare System for Modern Challenges

Syllabus:

GS-2:

HealthGovernment Policies & Interventions

GS -3:

Government BudgetingPlanning

Focus:

India’s public health system faces modern challenges such as chronic diseases, antimicrobial resistance, and mental health issues. The government’s Ayushman Bharat scheme, along with initiatives like Health and Wellness Centres, aims to address these challenges by improving healthcare accessibility and quality for all citizens.

Strengthening Primary Healthcare System for Modern Challenges

About Changing Dynamics of Public Health :

  • Nature of Public Health: Public health has evolved globally due to modern lifestyles and expanding economies. Health challenges like antimicrobial resistance, chronic diseases, zoonotic diseases, and mental health issues are reshaping health systems.
  • Modern Health Challenges:
    • Non-Communicable Diseases (NCDs): NCDs account for over 60% of global deaths and are expected to increase by 17% in the next decade.
    • Antimicrobial Resistance (AMR): An emerging threat exacerbating health challenges.
    • Mental Health and Zoonotic Diseases: Increasing concerns due to shifting environmental and socio-economic factors.

Ayushman Bharat and its Impact on Public Health:

Ayushman Bharat Scheme: Launched in the 2018 Budget, it aims to strengthen India’s health system and provide affordable healthcare to disadvantaged populations.

  • Key Components:
    • Pradhan Mantri Jan Arogya Yojana (PM-JAY): Offers financial protection of ₹5 lakh to BPL families and senior citizens.
    • Ayushman Arogya Mandir (AAM): Focuses on improving primary healthcare services through Health and Wellness Centres (HWCs).
    • Pradhan Mantri Ayushman Bharat Health Infrastructure Mission (PM-ABHIM): Strengthens the health infrastructure to support comprehensive care across the country.
    • Comprehensive Care: AAM centers provide preventive, curative, rehabilitative, and palliative care, emphasizing non-communicable diseases, mental health, and geriatric care.
    • Healthcare Financing: PM-JAY serves as the largest publicly funded health insurance program, shielding individuals from catastrophic health expenditure.

Understanding Indian Healthcare Sector :

Structure of Indian Healthcare System

●      Primary Healthcare:

○       Foundation of the system; provides basic health services.

○       Focuses on prevention, early diagnosis, and treatment.

○       Components: Health promotion, immunization, maternal and child health, disease prevention, and sanitation awareness.

○       Infrastructure:

■     Sub-Centres (SCs): Managed by ANMs, targeting rural populations.

■     Primary Health Centers (PHCs): Provide curative, preventive, and promotive care.

●      Secondary Healthcare:

○       Acts as a referral system from primary care, with specialized treatment.

○       Components: District Hospitals, Community Health Centers (CHCs), specialist services (gynecology, pediatrics, etc.), emergency care.

○       Infrastructure:

■     CHCs: Link between PHCs and tertiary care.

■     District Hospitals: Provide comprehensive care for larger populations.

●      Tertiary Healthcare:

○       Provides super-specialized care and advanced treatments.

○       Components: Super-Specialty Hospitals (cancer, neurosurgery, organ transplants), Teaching Hospitals, Private Hospitals.

○       Infrastructure:

■     Institutions like AIIMS and corporate hospitals offering high-end services.

Key Government Initiatives to Strengthen Healthcare:

●      Ayushman Bharat: Free health coverage for economically weaker sections for secondary and tertiary care.

●      National Health Mission (NHM): Focuses on improving healthcare infrastructure in rural areas.

●      Jan Aushadhi Scheme: Provides affordable generic medicines.

●      Mission Indradhanush: Aims for full immunization coverage.

●      Digital Health Initiatives: Implementation of e-health records and telemedicine for better accessibility.

Challenges within the Public Health System:

  • Trust Deficit:
    • Lack of Trust: In India, trust in the public health system remains low, especially in rural areas, impacting health-seeking behavior. People’s trust in healthcare influences utilization, continuity of care, and self-satisfaction.
    • Impact on Health Outcomes: Studies show that low trust correlates with poor health outcomes, lower usage of public health services, and a preference for private healthcare.
  • Private Sector Dominance:
    • Private Sector Reliance: Many individuals prefer private healthcare due to better infrastructure, timely access, and consistency.
    • Economic Strain: The private sector’s share in health spending remains significant, creating an imbalance in healthcare access, particularly for low-income groups.
  • Inadequate User Experience:
    • Blind Spots: Key blind spots in the public system include poor user experience and lack of transparency in service delivery.
    • Quality of Care: Despite improvements at the primary level, public health centers often fall short of expectations in terms of accessibility, quality, and patient satisfaction.

Efforts to Improve Public Health Infrastructure and Service Quality :

  • National Health Mission and Ayushman Bharat:
    • Strengthening Primary Health Care: The National Health Mission (NHM) and Ayushman Bharat work together to expand and enhance accessibility to public health services in urban and rural areas.
    • Health and Wellness Centres (HWCs): These centers are pivotal in providing a wide range of healthcare services, including mental health care, chronic disease management, and wellness programs, directly at the community level.
    • Integration of Public and Private Resources: Collaboration with private sector healthcare providers is being explored to strengthen the reach and quality of care.
  • National Quality Assurance Standards (NQAS):
    • Setting Global Standards: NQAS aims to upgrade the quality of care in public healthcare facilities to international standards. It covers aspects such as service, patient rights, infection control, clinical care, and patient outcomes.
    • Holistic Care Approach: The implementation of these standards is critical to ensuring that publicly funded health facilities offer care that is not only affordable but also of high quality.

Way Forward: Prioritizing Trust, Transparency, and Global Standards

  • Building Trust in Public Health Systems:
    • User-Centric Approach: To enhance trust, it is crucial to capture user experience data and make the findings publicly available. Transparency in service delivery will help increase confidence in the system.
    • Community Engagement: Continuous efforts to involve local communities in health programs can help bridge the trust gap and encourage utilization of public healthcare services.
  • Strengthening Infrastructure:
    • Focus on Health Infrastructure: Prioritize the construction and modernization of health facilities, particularly in rural and underserved areas.
    • Sustainable Funding Models: Ensure that healthcare infrastructure is supported by both central and state government funding, alongside public-private partnerships.
  • Global Standards in Healthcare:
    • Adopting International Health Standards: India must fully implement the NQAS and align its healthcare system with global best practices. A high-performing system should optimize healthcare delivery and consistently improve health outcomes.
    • Sustainable Development Goals (SDG) 2030: India’s commitment to achieving SDGs, particularly health-related goals, should focus on creating an inclusive, high-quality public health system that serves all citizens equitably.
  • Policy Reform and Action:
    • Comprehensive Health Reforms: Ensure that health policies and interventions address modern health challenges, such as NCDs and mental health, by integrating them into the broader public health framework.

Conclusion:

  • Ayushman Bharat’s Potential: The Ayushman Bharat scheme represents a significant step toward transforming India’s public health landscape by making healthcare more accessible and affordable for marginalized communities.
  • Public Health System Challenges: While the government has made strides in addressing health inequalities, issues like trust deficit and inadequate service quality still hinder the system’s effectiveness.
  • Strategic Investments: Addressing these issues through targeted investments in infrastructure, quality assurance, and trust-building measures will be critical for achieving a sustainable, high-quality healthcare system in India.

By focusing on strengthening the primary healthcare system, improving infrastructure, and addressing trust issues, India can improve its public health outcomes and move closer to achieving its SDG 2030 goals.

Source: TH

Mains Practice Question:

Discuss the significance of Ayushman Bharat in addressing India’s healthcare challenges, focusing on its impact on accessibility, quality of care, and the role of public-private collaboration in strengthening the system. How can India improve trust in its public health system? (50 words)