[8 April 2024] The Hindu Op-ed: Shaping India’s path to inclusive Health Care

PYQ Relevance:

Mains: 
Q) Public health system has limitation in providing universal health coverage. Do you think that private sector can help in bridging the gap? What other viable alternatives do you suggest? (UPSC CSE 2015) 
Q) The increase in life expectancy in the country has led to newer health challenges in the community. What are those challenges and what steps need to be taken to meet them? (UPSC CSE 2022) 

Prelims:
With reference to National Rural Health Mission, which of the following are the jobs of Asha, a trained community health worker?  (UPSC CSE 2012) 
1) Accompanying women to the health facility for antenatal care checkups
2) Using pregnancy test kits for early detection of pregnancy
3) Providing information on nutrition and immunization
4) Conducting the delivery of babySelect the correct answer using the codes given below:
(a) 1, 2 and 3 only
(b) 2 and 4 only
(c) 1 and 3 only
(d) 1, 2, 3 and 4

Note4Students: 

Prelims: National Health Policy; Ayushman Bharat;

Mains: Health Issues in India; Universal Health Coverage;

Mentor comments: Indian Health Policies since Independence have neglected diverse perspectives critical for public health systems at the local level. This diversity impacts the nature of policies made, “because we are looking only from a certain lens”. Recently, with the passage of World Health Day 2024, WHO promoted the idea that ‘Health Equity’ is a source of optimism for millions of people, going beyond social justice or legislative change. Now the issue is with the theme of World Health Day ‘my health – my right’. How should access to health be envisaged? Given that health is a state subject (Seventh Schedule) and the ‘Universal Health Coverage’ policy is envisaged at the National level, there is a need for discourses on implementation. 

Let’s learn. 

Why in the News?

The World Health Organization (WHO) has declared health to be a fundamental human right

  • India’s ‘Health Equity’ issues require a comprehensive approach that goes beyond improvements in healthcare facilities.
About World Health Day 2024:

World Health Day (April 7) unites every country around ‘Health Equity’, an essential topic at the heart of global health and justice. 

Theme for 2024:My Health, My Right”.Although over 140 nations recognize health as a Constitutional right, the WHO Council on the ‘Economics of Health for All’ reported that more than half the world’s population needs complete access to essential health services. 

There is an alarming gap in Indian health-care access, which was highlighted especially during the COVID-19 epidemic, environmental crises, and growing socio-economic gaps. 

What is meant by Health Equity?

Health Equity’ ensures that every person has an equal opportunity to achieve their highest health potential, no matter what their circumstances. 

WHO’s idea behind Health Equity – Ensuring Everyone’s Right to Health:

  • Aim: To eliminate unfair and preventable health disparities among different social and economic categories.
  • Significance:
    • Builds Equality: True health equity addresses the root causes of health inequities, such as poverty, discrimination, and limited access to resources.
    • Universal Coverage: Pandemics, climate change, and sociopolitical unrest exacerbate health inequities, particularly in diverse countries like India.
What does the Indian Statistics say?

1) 2011 Census: 

Infectious diseases, such as tuberculosis, are 1.5 times more common in slums due to overcrowding and poor sanitation as compared to non-slum areas, according to the Indian Council of Medical Research. Disparities across caste and gender are profound. 

2)National Family Health Survey (NFHS)-5 (2019-21) 

Minorities: SCs and STs experience higher child mortality and lower immunization rates. 59% of women in the lowest wealth quintile suffer from anemia, demonstrating the intersection of caste, gender, and economic status in health outcomes.Non-communicable diseases (NCDs) account for more than 60% of all fatalities in India. The economic effect of NCDs could surpass $6 trillion by 2030.

3)Public Health Foundation of India:
Shortage of Doctors: The WHO data indicates that there are only 0.8 doctors per 1,000 people, which is below the advised ratio. Even though over 75% of Health-care professionals work in metropolitan regions, which only account for 27% of the population, the shortage is particularly severe in rural areas. 
  • Limitations in India:
    • Diversity: The road to health equity is fraught with difficulties, ranging from deeply ingrained social injustices to global systemic health concerns, particularly in multicultural countries such as India.
    • Comprehensive Planning: Achieving health equity requires a comprehensive approach beyond legislative reform, addressing socioeconomic determinants of health.
    • Collaboration and Coordination: Realizing health potential demands collective effort by governments, communities, and individuals to remove barriers.
    • Accessibility: Health equity includes targeting marginalized and vulnerable groups, climate change disproportionately impacting low-income and vulnerable people, and conflicts disrupting healthcare provision.

Initiatives Taken by Government:

  • Ayushman Bharat Initiative: This initiative provides free health coverage to the bottom 40% economically, demonstrating a commitment to reducing health disparities.
  • National Health Mission (NHM): It includes both the National Rural Health Mission (NRHM) and the National Urban Health Mission (NUHM), thus reducing the healthcare gap between rural and urban India. It expands its access by strengthening infrastructure and providing essential services to vulnerable populations.

Way Forward:

  • Requires a Comprehensive Approach: To move India towards Universal Health Coverage and a more equitable future, the government, civil society, healthcare providers, and communities need to work together.
  • Tap Organizations Together: Organizations (Non-Governmental organizations and Civic Societies) with a strong local presence are essential for health equity. They actively participate in every phase, from planning to evaluation, to guarantee the relevance and effectiveness of health programs. 
  • Successful collaborations: Need for open communication, respect for one another, and common goals because this can strongly emphasize empowering communities, sharing knowledge, and building capacity. For Example, WHO, the Global Fund and Gavi support health initiatives.
  • Building R&D: Research institutes and academic institutions offer crucial insights into health inequalities and the efficacy of interventions, assisting in creating evidence-based practices and policies supported by scientific studies.
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