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The deteriorating condition of public health centres in India, often described as emblematic of the country's failing healthcare system, has garnered attention due to a recent paper challenging this narrative. The paper highlights the ongoing struggles faced by these centres while also acknowledging signs of improvement and potential for redemption.

1: Dimension- Role of Health Centres in India's Healthcare System:

• Backbone: Health centres form the backbone of India's public healthcare system, providing essential primary care services across the country.
• Accessible and affordable healthcare: Comprising sub-centres, public health centres (PHCs), and community health centres (CHCs), these facilities aim to offer accessible and affordable healthcare, particularly in rural areas.

2: Dimension- Challenges Faced and Implications for Healthcare Equity:

• Ineffectiveness: Despite their vast number, reports indicate that less than 20% of these centres operate effectively, leading many underserved communities to rely on costly private healthcare services.
• Burden on patients: The prevalence of inadequate health centres contributes to significant health and financial burdens on patients, with nearly half of health expenditures in India still borne by individuals.

Study Overview and Scope:

Researchers examined 241 health centres across - Bihar, Chhattisgarh, Himachal Pradesh, Jharkhand, and Rajasthan, with Himachal Pradesh noted as a longstanding leader in healthcare provision.

• Positive improvements: Contrary to common perceptions, the study found evidence of functionality across public health centres, indicating consistent operational hours, patient treatment, basic facilities, and largely free healthcare services, particularly notable in states other than Bihar.
• The flip side: The study highlights modest improvements in health centres, with ongoing challenges such as staff absenteeism, limited services, and poor-quality care, particularly evident in Bihar.
  • Neglected issues include insufficient staff, funding irregularities, inadequate facilities, and social discrimination based on caste, class, gender, and religion.
  • Investment in healthcare increased, but the “improvements are patchy” and allocations prioritise material development in tertiary healthcare.
• What changed between 2002 and 2022? The share of health expenditure in the Union Budget increased drastically, coupled with the introduction of the National Rural Health Mission. India’s flagship Ayushmann Bharat programme, launched with the vision of achieving universal health coverage, in 2018 introduced a health insurance component (PMJAY) and a public provision component through health and wellness centres (HWCs). Top of Form

Expanding and enhancing the functionality of health centres could serve as a pivotal solution to address social and health disparities, offering localized and more effective healthcare delivery compared to larger hospitals or private facilities.