FOUNDATION COURSE 2

INDIA’S DEVELOPMENTAL CHALLENGES

FINAL ASSESSMENT

SUBMITTED BY

GONELA KRISHNA VAMSY – M2022LSP007

SECTION A

Q 2.Tracing the evolution of the health care system in India, explain the reason for inequalities in access
to healthcare in India?

‘’HEALTH IS THE GREATEST OF ALL HUMAN BLESSINGS,’’

Hippocrates

An effective, well functioning, accessible and affordable quality health care system is a pre
requisite for ensuring a healthy population.

India’s current health care system has evolved largely based on the Health survey and
development committee report, known as the Bhore committee report of 1946. The current mixed
three tier health care system model has been modelled based on its recommendations such as

(a)Integration of preventive and curative services at all levels

(b)three tiered health care system

(c)Placing health workers in government payrolls

(d) Limiting the need for private health care practitioners etc.

Health care is a public good characterized by non rivalry and non excludability.Supreme Court in
Bandua Mukthi Morcha vs Union of India case has linked Right to health as an integral part of Right to
Life under A 21. A47 of the Constitution also directs State to implement policies to improve public
health. India is also a signatory of the UN International Covenant on Social and Economic Rights,
Universal declaration of Human Rights. India’s mixed health care system(public and private ) and
welfarist orienration also necessitates the central role of State in provision of health care.

India is also striving to attain Sustainable Development Goal 3 on Quality healthcare based on
the principle of leaving no one behind. To secure this Access to quality health care assumes paramount
importance.

The first phase in the evolution of health care system(1940-78) includes the steps taken as per
the Bhore Committee report, formulation of the National Health Policy. This phase included the disease
control programmes and the family planning programmes. Water supply was removed from health
sector in the fifth five year plan period leading to problems in addressing health issues arising out of
water and sanitation. Integrated Child development scheme(ICDS) became independent of the health
care with minimal intersectoral linkage during this phase, thereby breaking the continuity in health care
planning.

The second phase from 1978-91, included expansion of primary health care and signing of the
Alma Ata declaration of UNICEF.

The third phase from 1991-2005 during the post liberalization era witnessed structural
adjustment policies in healthcare, enhanced privatization in the health sector with expansion of
corporate multi speciality hospitals due to neo liberal policies of the government, reduction in public
spending on health care. All of this led to the National Health Policy of 2002 which was an open call for
privatization. Health transformed into medical care with more importance to the curative care driven
model thereby resulting in the neglect of the primary health care.

The fourth phase during 2005-15, witnessed National rural health mission and renewed
attempts to revive the public helath sector. Mix of new public management and partnership with NGO
was emphasized. Universal Health Care became a priority and National Health Authority was
created.This phase also saw the politics of insurance with competing private players in the insurance
sector. State government health insurance schemes like Arogya Sri in Andhra Pradesh also picked up.

The Current phase of health care includes emphasis on preventive as well as curative care with
Ayushman Bharat – National Health Protection Mission(AB-NHPM) , increase in public spending on
health care to 2.5% of GDP as envisaged under the National Health Policy of 2017. The COVID
pandemic also has highlighted the importance of public sector and coordination between the union and
states and public – private partnerships to tackle public health emergencies. Mental Health care has
gained importance and attention with the enactment of the Mental Health Care Act,2017. Health
insurance penetration and coverage also increased after COVID.

Inequalities in access to health care in India:

Lack of equity results in challenges of responding to the needs of the disadvantaged

sections of the society. Despite advancements, inequalities in access to quality health care exist
according to gender, region, socio economic status –caste and class. For example, inequalities in
immunization coverage exist with 31.3% coverage in Scheduled Tribes and 39.7% coverage in Scheduled
Castes as against 53. 8 % in other sections(2005-06). ABHAY BANG committee report on tribal health in
India points out that tribals suffer from triple burden of malnutrition, communicable diseases like
malaria, tuberculosis and non communicable diseases like cancer, diabetes etc.
 1. Inequities in access to health care arises out of various factors such as caste, class,
region, gender.
2. The marginalized sections are denied access to health care in some cases and also the
services are not affordable. The health care system at times is designed to address the
health issues of the affluent sections of the society, neglecting the issues specifically
concerning the tribals, dalits etc.
3. Women are denied access due to stigma attributed to women’s reproductive rights and
health issues and are their health concerns are considered secondary to men.
4. Regional disparity in terms of low level of health care infrastructure and practitioners in
rural areas exists. Problem of Quack doctors also persists.
5. Inadequate public investment in health care at 1.4% of GDP as against the 2.5% GDP
target of NHP 2017
6. Health care services being driven by profit maximizing motive rather than looking it as a
public good
7. High out of pocket expenditures pushing the vulnerable sections into poverty.
8. Rising costs and unregulated commercialization
9. Lack of accountability in public and private sectors
10. COVID pandemic has highlighted how the poor and marginalized sections suffer
disproportionately due to low purchasing power.

WAY AHEAD:

Effective implemention of Ayushman Bharat – 1,50000 health and wellness centres expanding
the PHC network, integration of alternate medical care- AYUSH with modern hospitals. Health being a
state subject need effective coordination between centre and states to ensure health and well being of
all. Reforms in the medical education system is also an important step

Also health systems need to be inclusive of all sections – by provision of quality geriatric
care for elderly, address the health care necessities of persons with disabilities, LGBTQ community,
reproductive and maternal and child health care. Health care insurance should be modelled on the lines
of the tax funded UK model to ensure accessibility and affordability of quality health care to all. Digital
health and mental health should be accorded more importance.

SARVE BHAVANTU SUKHINAH

SARVE SANTU NIRAMAYA