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Public Health centers in India UPSC NOTE

 State of public health centers in North India

  • There is a well-documented infamy around public health centres

  • Some have likened it to a chasm, others to a systemic rot representing the “greatest failure of the Indian state”. 

  • There is proven dilapidation and disrepute — there are no doctors, no diagnostics, no drugs.

  • There are no buildings either sometimes, and people walk for miles to get substandard treatment. 

  • These centres, as reflections of the vast network of public healthcare, stoke the fear that India’s health system has either collapsed or is disintegrating rapidly.

  • In this paper, the authors counter and complicate the prevailing narrative of ‘collapse’.

  • They present a portrait of the healthcare centres in five north Indian States, documenting their strengths and struggles alike. 

  • Their survey shows a pattern of “improving quality and utilisation over time”, but the nature of progress is “largely cosmetic”, and “the pace of improvement” remains “far from adequate”. 

Importance of Health Centers

  • Health centres are the lowest rung of India’s public health system, charged with offering accessible and affordable primary care

  • Almost two lakh in number, they are conceptualised as a three-tier system: sub-centres (later renamed as health and wellness centres), public health centres (PHCs) and community health centres (CHCs). 

  • 94% of these centres are located in rural areas,

  • The reports show that less than 20% of them function effectively.

  • This pushes disadvantaged communities to rely on expensive, exploitative private health care.

  • Last year’s Economic Survey showed that in the absence of proper insurance and affordable services, almost half of all health spending in India is still paid by patients themselves, pushing many households into poverty.

  • The answer to social and health inequity may lie in accelerating the expansion and improvement of health centres. 

  • Localised healthcare “is a much better way of dealing with most health problems than to let patients loose on larger public hospitals or the private sector”.

Findings - Way Forward

  • Investment in healthcare increased, but the “improvements are patchy” and allocations prioritise material development in tertiary healthcare

  • Take the composition of the healthcare budget: the allocation in 2022–23 (1.9%) was almost the same as a decade ago in 2013–14 (1.7%). 

  • The National Health Mission share shrank from 69% to 44%. 

  • In comparison, the government spent 10 times as much money on PMJAY and new regional AIIMS hospitals than on public welfare arms like the HWCs. 

  • The researchers poked holes in the claim that lakhs of HCWs were ‘created’ — these were “minor upgrade[s]” of existing centres. 

  • The HWCs “have a relatively attractive look” but were only “marginally better” than sub-centres, with improvements only “cosmetic” in nature.

  • The study sketches India’s health centres as sites of hope, debunking cynicism surrounding its failures and dissects claims of progress.

  • These struggles “cannot be regarded as successful, but nor is it hopeless”, because “hope lies in the experiences of States that have shown how decent standards of healthcare can be achieved in the public sector”. 

  • The researchers conclude by noting that “beyond the current tokenism of Ayushmann Bharat”, “major support from the centre...would make it much easier for the poorer states to emulate these initiatives”.


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Learnerz IAS | Concept oriented UPSC Classes in Malayalam: Public Health centers in India UPSC NOTE
Public Health centers in India UPSC NOTE
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