Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.

Have India’s health centres really ‘collapsed’?

Note4Students

From UPSC perspective, the following things are important :

Prelims level: Primary Health Centres (PHCs)

Mains level: Read the attached story

health centres

In the news

  • Public health centres in India have long been shrouded in infamy, perceived as symbols of systemic failure.
  • The effectiveness of primary healthcare in India has always been a topic of discussion, with calls for strengthening these services through government commitment to accessibility, affordability, and quality care.

PYQ from CSE Mains 2021:

 

Q. “Besides being a moral imperative of a Welfare State, primary health structure is a necessary precondition for sustainable development.” Analyse.

Health Centres in India

  • Primary Health Centres (PHCs) also known as Public HCs play a crucial role in providing comprehensive healthcare services to the population.
  • The first PHC in India was established following the proposal of the PHC concept in a paper submitted to the Executive Board of the World Health Organization (WHO) in January 1975.
  • The establishment of PHCs gained further momentum with the International Conference on PHC held in Alma Ata, Kazakhstan in 1978.
  • They are a fundamental component of the healthcare system, with Medical Officers at these centers required to hold an MBBS degree.
  • India boasts a vast public health infrastructure with 23,391 PHCs and 145,894 sub-centers, serving a substantial percentage of the population.
  • PHCs cover a significant portion of outpatient care, including services for non-communicable diseases, maternal health, and child health.

Importance of Health Centres

  • Foundational Role: Health centres form the backbone of India’s public health system, providing primary care to millions.
  • Access and Affordability: With nearly two lakh centres across the country, they aim to offer accessible and affordable healthcare, particularly in rural areas.
  • Impact on Equity: Effective health centres can mitigate social and health inequities, reducing reliance on costly private healthcare and preventing households from falling into poverty due to healthcare expenses.

Unveiling the Reality

  • Evidence of Progress: Surveys conducted across five states reveal a pattern of improving quality and utilization of health services over time, albeit at a slow pace.
    1. In Himachal Pradesh, functional health centres serve 83% of the population.
    2. Chhattisgarh has shown a radical expansion in the public provision of healthcare, with increased facilities, medicines, and staff presence.
    3. Bihar lags behind, with dismal quality of health centres and some sub-centres being dormant or non-existent.
  • Policy Interventions: Increased health expenditure, initiatives like the National Rural Health Mission, and state-specific schemes have contributed to incremental improvements.
    1. The share of health expenditure in the Union Budget increased drastically.
    2. The National Health Mission’s share shrank from 69% to 44%, while allocations for the Ayushmann Bharat program and new AIIMS hospitals surged.
    3. COVID-19 led to a sustained increase in patient utilization of public health facilities, indicating growing trust in the system.

Challenges and Gaps

  • Underutilization: Despite improvements, health centres still face challenges such as high staff absenteeism, limited services, and poor infrastructure.
  • Lacunas: Health workers report irregular flow of funds, lack of facilities like toilets and transport, and inadequate supply of drugs and testing equipment.
  • Social Discrimination: Caste and gender dynamics influence access to and quality of healthcare, perpetuating inequalities. Upper-caste doctors display disparaging attitudes towards marginalized communities, while upper-caste families disrespect Dalit ANMs.
  • Gender Disparities: Women, particularly frontline health workers, play a crucial role in rural health settings but often face neglect and discrimination.

Way forward

  • Holistic Investment: While progress has been made, it remains patchy, with allocations often prioritizing tertiary healthcare over primary care.
  • Designated allocations: The composition of the healthcare budget has remained stagnant, with minimal increases in the share allocated to primary healthcare.
  • Policy Reform: The paper advocates for substantial support from the central government to enable poorer states to replicate successful initiatives and enhance the role of health centres in public healthcare delivery.

Conclusion

  • India’s health centres, though fraught with challenges, embody resilience and potential.
  • By addressing systemic gaps and prioritizing primary healthcare, the nation can harness the transformative power of these centres to achieve equitable and accessible healthcare for all.

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