Public Health Needs and Policies

1. Diverse Public Health Needs

• Public health needs in a population are diverse and vary across social strata. These needs can be broadly categorized into felt needs (experienced by people) and projected needs (identified by experts).

2. Critique of Public Health Policies

• The Union Budget and public health policies over the last decade have been critiqued for inadequate focus on the social sector, especially public health. There has been a perceived paralysis in policy-making, with little attention to the felt needs of the population.

Categories of Public Health Needs

1. Diseases of Poverty

• Includes tuberculosis, malaria, undernutrition, maternal deaths, and water-borne infections like typhoid and diarrheal diseases.
• Addressing these issues also involves tackling related livelihood challenges.

2. Problems of the Middle Class

• Environmental pollution, poor infrastructure, market regulations, road traffic accidents, and chronic illnesses.
• These issues impact both the middle class and the poor but may not be prioritized equally.

3. Curative Care Needs

• Encompasses primary, secondary, and tertiary care.
• Primary care is essential for the poor and vulnerable; secondary care has been historically neglected, while tertiary care is now focused on under schemes like PMJAY under Ayushman Bharat.

Evolution of Indian Public Health Policies

1. National Rural Health Mission (NRHM) and National Health Mission (NHM)

• The NRHM (2005) and NHM (2013) were significant shifts from the 2002 National Health Policy, focusing on strengthening public health care and primary health institutions.

2. Shift to Publicly Funded Health Insurance Schemes (PFHI)

• Since 2018, the focus has shifted to schemes like PMJAY under Ayushman Bharat, which benefits private sector healthcare, sidelining the strengthening of secondary and tertiary public healthcare.

The Role of Private Health Care

1. Dominance of the Private Sector

• PFHI schemes primarily benefit the private sector by covering only hospitalization expenses, leaving a significant portion of the population dependent on expensive, commercialized private care.

2. Outsourcing of Healthcare Services

• The government’s outsourcing of secondary and tertiary care to the private sector reflects its failure to strengthen public healthcare, forcing many to rely on costly private services.

Transformation of Public Health Institutions

1. Health and Wellness Centres (HWCs)

• Sub-centres, PHCs, and CHCs were transformed into HWCs in 2018, with a new focus on curative care. This shift undermined the original mandate of primary health institutions to provide preventive and promotional health services.

2. Renaming of HWCs

• The 2023 directive to rename HWCs as ‘Ayushman Arogya Mandir’ has raised questions about the relevance and secular nature of the name, especially for non-Hindi speaking populations.

Threats to the Public Health System

1. Neglect of Vulnerable Populations

• The vulnerable and poor rely heavily on basic primary and secondary curative care. However, the government’s focus on curative care has led to the weakening of preventive and promotional health activities.

2. Loss of Trust in Healthcare Providers

• Overcrowding, inadequate infrastructure, and commercial interests have led to a loss of trust in both public and private healthcare providers.

3. Weakening of Primary Healthcare

• The transformation of primary healthcare institutions into curative care centres, driven by popularity and branding, has undermined their fundamental role in delivering preventive and promotional health services.

Conclusion

The government’s focus on publicly funded health insurance schemes, coupled with the neglect of primary and secondary public healthcare, poses a significant threat to India’s public health system. There is a need to realign policies to address the diverse and felt needs of the population, especially the poor and vulnerable.