Beyond Doorstep Health Care

With schemes like Tamil Nadu’s MakkalaiThediMaruthuvam (2021) and Karnataka’s Gruha Arogya (2024–25) delivering healthcare at the doorstep, there is renewed focus on the extent of citizen participation in shaping health governance.

Evolution and Importance of Citizen Engagement

• Expanding Stakeholders in Health Governance: Once a government-led function, health governance now includes civil society, professional bodies, trade unions, and community groups, functioning through both formal and informal processes influenced by power dynamics.
• Democratic and Accountability Benefits: Public engagement affirms dignity, addresses epistemic injustice, challenges elite dominance, reduces corruption, and strengthens trust between providers and communities.
• Institutionalised Platforms under NRHM: The National Rural Health Mission (2005) created Village Health Sanitation and Nutrition Committees (VHSNCs) and Rogi Kalyan Samitis, along with urban Mahila Arogya Samitis, but many remain non-functional or face issues such as unclear roles, irregular meetings, and poor fund utilisation.

Structural Challenges in Participation

• Mindset of Policymakers and Providers: Communities are often seen as passive “beneficiaries” rather than rights-holders, with programme performance assessed by numerical targets rather than quality of engagement.
• Dominance of Medicalised Administration: Health leadership across levels is typically held by doctors trained in biomedical models, promoted on seniority rather than public health expertise, limiting community-oriented governance.
• Barriers and Resistance: Concerns about workload, accountability pressures, capture by elite interests, and absence of equitable governance processes discourage genuine citizen participation.

Pathways to Meaningful Engagement

• Empowering Communities: Disseminating information on health rights, fostering early civic awareness, intentionally reaching marginalised groups, and providing tools for effective participation in decision-making.
• Sensitising Health System Actors: Moving beyond blaming poor awareness for low health-seeking behaviour, and addressing structural determinants of health inequities collaboratively.
• Strengthening Engagement Platforms: Ensuring public participation bodies are not only established but actively functional, inclusive, and capable of influencing health policy and service delivery.

Practice Question:

"Discuss the role of citizen engagement in ensuring effective and equitable health governance in India. Analyse the institutional and structural barriers to such participation and suggest measures to overcome them."