Why in the News?

Public health has evolved with the growing economy and modern lifestyles. Key challenges include antimicrobial resistance, chronic diseases, zoonotic diseases, and mental health, with NCDs making up 60% of global deaths.

What are the key modern public health challenges faced globally, and how do they impact India?

• Rise of Non-Communicable Diseases (NCDs): NCDs like heart disease, diabetes, and cancer account for over 60% of global deaths and are projected to rise by 17% in the next decade. India faces a dual burden of NCDs and infectious diseases. Eg: As per National Family Health Survey (NFHS-5), over 20% of Indian adults suffer from high blood pressure.
• Antimicrobial Resistance (AMR): Misuse of antibiotics in humans and livestock has led to drug-resistant infections, making common illnesses harder to treat. India is one of the largest consumers of antibiotics, and AMR increases mortality rates and healthcare costs. Eg: A 2019 ICMR report showed a rise in resistance to last-resort antibiotics like colistin in Indian hospitals.
• Mental Health Crisis: Stress, urbanization, and socio-economic pressures are driving a rise in mental health illnesses, yet policymakers and health systems continue to under-address them. India has a high treatment gap — about 80% of people with mental illness do not receive treatment due to stigma and lack of resources. Eg: WHO estimates that India loses nearly $1 trillion in productivity annually due to mental health issues.

How does the ‘Ayushman Bharat’ scheme aim to strengthen India’s public health system?

• Financial Protection through PM-JAY: The Pradhan Mantri Jan Arogya Yojana (PM-JAY) offers ₹5 lakh health insurance coverage per family per year to poor and vulnerable populations. It reduces the financial burden of hospitalization and protects against catastrophic health expenditure. Eg: A BPL family needing heart surgery under PM-JAY can avail treatment in empanelled hospitals without paying out-of-pocket.
• Strengthening Primary Healthcare via Ayushman Arogya Mandirs (AAMs): These upgraded Health and Wellness Centres (HWCs) provide comprehensive care, including preventive, promotive, curative, rehabilitative, and palliative services, close to communities. Eg: A rural health centre now screens for diabetes, mental health, and cancers under the AAM model, increasing early detection and timely treatment.
• Infrastructure Development through PM-ABHIM: The Pradhan Mantri Ayushman Bharat Health Infrastructure Mission (PM-ABHIM) improves health system preparedness by investing in labs, critical care units, and public health surveillance systems. Eg: District hospitals are being upgraded with ICU beds and disease monitoring labs under PM-ABHIM, boosting emergency response and pandemic readiness.

What are the reasons behind the lack of trust in India’s public health system?

• Poor User Experience and Service Quality: Long wait times, overcrowding, and inadequate attention from healthcare staff often lead to patient dissatisfaction and erode trust in public facilities. Eg: Patients at many government hospitals report delays in receiving treatment due to staff shortages and administrative inefficiencies.
• Inconsistent Infrastructure and Cleanliness: Lack of clean facilities, essential medicines, and functional equipment in some centers diminishes public confidence in receiving quality care. Eg: A 2022 Health Ministry survey found that several PHCs in remote areas lacked basic amenities like running water and power backup.
• Stigma and Miscommunication in Care Delivery: Lack of sensitivity among staff, especially in mental health and maternal care, coupled with poor communication, creates a sense of neglect or discrimination. Eg: Many rural women avoid public health centers for childbirth due to past experiences of rude treatment or neglect by staff.

How does the quality and accessibility of private healthcare in India compare to the public sector?

• Better Infrastructure and Perceived Quality in Private Sector: Private hospitals often offer cleaner facilities, modern equipment, and shorter wait times, making them the preferred choice for many. Eg: Urban patients may choose a private multispecialty hospital over a government facility due to advanced diagnostic tools and faster service.
• Higher Costs and Risk of Catastrophic Expenditure: While private healthcare ensures timely treatment, it comes at a high cost, which can push middle- and low-income families into debt. Eg: A cancer patient undergoing chemotherapy in a private hospital may face bills in lakhs, unlike subsidized or free treatment in public hospitals under schemes like PM-JAY.
• Limited Accessibility for Rural and Poor Populations: Private hospitals are concentrated in urban areas and are often unaffordable for rural or economically weaker sections, widening the healthcare gap. Eg: A villager may have to travel over 50 km to access private healthcare, while a nearby government PHC is under-equipped or understaffed.

What is the role of National Quality Assurance Standards (NQAS) in enhancing public health services in India?

• Improves Service Delivery and Patient Care: NQAS ensures that healthcare facilities follow standardized procedures, improving the quality, safety, and effectiveness of care provided. Eg: A district hospital certified under NQAS follows set protocols for infection control and patient safety, reducing the chances of hospital-acquired infections.
• Builds Accountability and Performance Monitoring: Facilities are regularly assessed on key quality indicators, encouraging a culture of accountability and continuous improvement. Eg: A Primary Health Centre (PHC) striving for NQAS certification upgrades its infrastructure and staff training to meet quality benchmarks.
• Enhances Public Trust in Government Facilities: By aligning public health facilities with global standards like ISQua, NQAS boosts confidence among patients to seek care from government institutions. Eg: An NQAS-certified Community Health Centre (CHC) attracts more patients due to its improved cleanliness, better staff behaviour, and reliable service delivery.

Way forward: 

• Invest in Quality and Infrastructure: Strengthen public health facilities with adequate staff, modern equipment, and essential supplies to ensure reliable, high-quality care across rural and urban areas.
• Promote Awareness and Trust: Launch community-based health education campaigns and feedback mechanisms to reduce stigma, improve service perception, and increase public trust in government healthcare systems.

Mains PYQ:

[UPSC 2021] “Besides being a moral imperative of a Welfare State, primary health structure is a necessary precondition for sustainable development.” Analyse.

Linkage: The importance of a strong primary health structure, which is fundamental to making healthcare accessible and achieving broader development goals.

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