BA (JMC) 108: Health Journalism

Unit 1 (Introduction to Public Health)

By Dr. Saima Pervez

Public Health Care System in India

Issues & Problems in Rural and Urban India
Introduction

Good health is one of the basic human needs and worldwide recognized goal for faster socio-
economic development. Health is an important aspect of human life, and at present it has also
become an important aspect of any nation’s public services and planning. Every country,
whether developed or developing nation has its own policy or public healthcare delivery
system.

The public health system in India comprises a set of state-owned health care facilities funded
and controlled by the government of India. Some of these are controlled by agencies of the
central government while some are controlled by the governments of the states of India. The
governmental ministry which controls the central government interests in these institutions is
the Ministry of Health & Family Welfare.

Public Health Care System in India

India's Ministry of Health was established with independence from Britain in 1947. The
ministry is composed of two departments: Department of Health and Family Welfare and
the Department of Health Research. The government has made health a priority in its series
of five-year plans, each of which determines state spending priorities for the coming five
years.

The National Health Policy was endorsed by Parliament in 1983. The policy aimed at
universal health care coverage by 2000, and the program was updated in 2002, then again
updated in 2017. The recent four main updates in 2017 mentions the need to focus on the
growing burden of non-communicable diseases, on the emergence of the
robust healthcare industry, on growing incidences of unsustainable expenditure due to health
care costs and on rising economic growth enabling enhanced fiscal capacity.
India has a vast health care system, but there remain many differences in quality between
rural and urban areas as well as between public and private health care. Rural areas often
suffer from physician shortages, and disparities between states mean that residents of the
poorest states often have less access to adequate healthcare than residents of relatively more
affluent states. State governments provide healthcare services and health education, while the
central government offers administrative and technical services.

The health care system in India is primarily administered by the states. India's Constitution
tasks each state with providing health care for its people. In order to address lack of medical
coverage in rural areas, the national government launched the National Rural Health
Mission in 2005. This mission focuses resources on rural areas and poor states which have
weak health services in the hope of improving health care in India's poorest regions.

Issues and Problems in Rural and Urban India

The causes of health inequalities lie down in the social, economic and political mechanisms
that lead to social stratification according to income, education, occupation, gender and race
or ethnicity. Lack of adequate progress on these underlying social determinants of health has
been acknowledged as a glaring failure of public health.

Rural versus Urban Divide: India still spends only around less than two per cent of
its national GDP towards healthcare goods and services. Additionally, there are wide
gaps between the rural and urban populations in its healthcare system which worsen
the problem. A staggering 70% of the population still lives in rural areas and has no or
limited access to hospitals and clinics consequently, the rural population mostly relies
on alternative medicine and government programmes in rural health clinics. In
contrast, the urban centres have numerous private hospitals and clinics which provide
quality healthcare. These centres have better doctors, access to preventive medicine,
and quality clinics which are a result of better profitability for investors compared to
the not-so-profitable rural areas.

Awareness (or the lack of it): Lack of awareness is a problem which is faced in
building access to healthcare. Mass awareness is important since even if the treatment
is free, unless the masses are educated and informed about the symptoms of the
diseases, its repercussions and complications and finally the treatment available, there
is no guarantee that people will avail these. How aware is the Indian population about
 important issues regarding their own health? 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.

Access to Health Care: Poor housing condition, unsafe drinking water, lack of
sanitation, use of biomass fuels, exposure to environmental odds as a part of the
livelihood among the marginal population group often increase the risk of numerous
health problems. Access to health care is very much asymmetric between rural and
urban India. While urban residents have a choice between public or private providers,
the rural residents face far fewer choices.

A good system of regulation is fundamental to successful public health outcomes. It reduces

exposure to disease through enforcement of sanitary codes, e.g., water quality monitoring,
slaughterhouse hygiene and food safety. Wide gaps exist in the enforcement, monitoring and
evaluation, resulting in a weak public health system. This is partly due to poor financing for
public health, lack of leadership and commitment of public health functionaries and lack of
community involvement.

Revival of public health regulation through concerted efforts by the government is possible
through updating and implementation of public health laws, consulting stakeholders and
increasing public awareness of existing laws and their enforcement procedures. There are
several shortfalls that need to be addressed in the development of human resources for public
health services. There is a dire need to establish training facilities for public health specialists
along with identifying the scope for their contribution in the field.

The Public Health Foundation of India is a positive step to redress the limited institutional
capacity in India by strengthening training, research and policy development in public health.
Pre service training is essential to train the medical workforce in public health leadership and
to impart skills required for the practice of public health. Changes in the undergraduate
curriculum are vital for capacity building in emerging issues like adolescent health and
mental health. In service training for medical officers is essential for imparting management
skills and leadership qualities. Equally important is the need to increase the number of
paramedical workers and training institutes in India.
Medicines could be made more affordable by ensuring steps like more investments in health
infrastructure, improved low cost diagnostics and a way to make the human resources
required for the same accessible to large sections of our population Along with free
medicines, generic alternatives and free diagnostics, healthcare is improving in India, at least
is some states.

One thing that we do need to be cautious of is about regulating prices and not letting
insurance providers control the healthcare system channelled through insurance and
infrastructure strengthening, is inadequate to address the current problems of unaffordable
health care and heavy financial risk, and the future challenges posed by aging populations
that are increasingly affected by non-communicable diseases. Healthcare should remain
democratic and consumer driven.

Key indices like maternal mortality rate and infant mortality rate are amongst the worst in the
country. Unfortunately this situation continues despite the government coming out with large
scale initiatives. Out of pocket health expenditure caused due to lack of access to adequate
public healthcare is preventing a large section of population from climbing above the poverty
line and pushing another large section back below the line.

Health care service in India needs to strengthen and expand the role of hospital accrediting
agencies and make compliance mandatory for all healthcare organizations. It needs to
promote the development of specialist medical bodies that govern and oversee the practice of
members of their specialty and issue periodic guidelines and clinical pathways to attain
uniform practice. It needs to follow good advice about healthy lifestyles, eating habits and
exercise and undergo periodic screening tests as appropriate. India suffers a large proportion
of the disease burden of the world, which has been estimated to be more than its 16.8% share
of the world's population.

One of the vital elements in improving this situation is the need for a comprehensive and
relevant evidence base that would equip India to take informed actions. A systematic
assessment of recent health research output from India is not available. Without objective
information about the current deficiencies and strengths in the health research output from
India, it is difficult to plan substantial improvements in health research output that could
enhance India's health status.
References:

Kasthuri, Arvind. "Challenges to healthcare in India-The five A's." Indian journal of

community medicine: official publication of Indian Association of Preventive & Social
Medicine 43.3 (2018): 141.

S.R Sudha, “Public Health in India: Issues and Challenges” International Research Journal
of Interdisciplinary & Multidisciplinary Studies 2.6 (2016) 29-36.

Shivamogga, Shankaraghatta. "Public Health in India: Issues and Challenges Dr. Sudha. SR."

Total word count: 1497

Release date: 13.04.2020