Policy paralysis, a weakened public health sector

The critique of recent Indian public health policies has intensified, focusing on the perceived inadequacy of the Union Budget’s allocation to the public health sector and the inefficacy of policies in addressing the felt needs of various social strata. The critique emphasizes the shift from strengthening public health infrastructure to promoting private sector benefits through health insurance schemes.

Felt Needs in Public Health

• Diseases of Poverty: Public health needs include diseases prevalent among the poor, such as tuberculosis, malaria, and undernutrition. Addressing these requires fundamental improvements in livelihood and access to basic health services, which are seen as non-negotiable rights.
• Middle-Class Health Issues: Middle-class and higher-income groups face health problems related to environmental pollution and poor infrastructure, including air and water quality issues, and traffic accidents. These issues often arise from inadequate urban planning and regulatory failures.
• Curative Care Needs: Curative care needs are categorized into primary, secondary, and tertiary levels. Primary care is crucial for the poor, while secondary care has historically been neglected. Tertiary care, notably through schemes like PMJAY, focuses on high-cost treatments for those unable to afford them.

Historical Perspective of Public Health Policies

• National Health Mission (NHM): Initiated in 2013, NHM aimed to strengthen public sector health care by reinforcing primary health care institutions. It marked a shift from the commercialization approach of the National Health Policy of 2002, focusing on improving public sector health infrastructure.
• Public Sector Health Infrastructure: The NHM led to significant infrastructure improvements, with 1,53,655 sub-centres, 25,308 primary health centres (PHCs), and 5,396 community health centres (CHCs) reported by 2015. This was intended to enhance accessibility and quality of public health services.
• Shift to Health Insurance Schemes: Recent policies, particularly since 2018, have shifted focus to publicly funded health insurance schemes like PMJAY. This shift has been criticized for diverting attention from strengthening secondary and tertiary public health care and benefiting the private sector instead.

Critique of Current Public Health Policies

• Privatization of Health Care: Health insurance schemes under PMJAY have led to the outsourcing of secondary and tertiary care to private providers. This has been criticized as acknowledging the failure of public sector health care while burdening the uninsured with commercial medical expenses.
• Transformation of Health Centres: The conversion of sub-centres and PHCs into Health and Wellness Centres (HWCs) has led to a misalignment of their original mandate. The focus on curative care at these centres risks undermining their role in preventive and primary health care.
• Name Change Controversy: Recent renaming of HWCs to 'Ayushman Arogya Mandir' has faced criticism for lacking clear justification and potential cultural insensitivity. This change raises questions about the appropriateness of the new nomenclature for secular health institutions.

Practice Question

Q: Public health challenges are diverse in a country such as India. Discuss how the inadequacy of addressing day-to-day livelihoods impacts the effectiveness of prevention programs and health promotion activities.