Public health needs are diverse, and perceptions of these needs vary across social strata.
Public health policies are government decisions made based on available resources to address people's health needs.
Public health needs are divided into:
Felt Needs: Those experienced by people based on their lived experiences.
Projected Needs: Needs identified by experts and policy architects for the population.
The recent Union Budget has been critiqued for insufficient focus on the social sector, particularly public health.
Public health needs can be categorized into three main groups:
Diseases of Poverty:
Includes tuberculosis, malaria, undernutrition, maternal deaths, and food/water-borne infections (e.g., typhoid, hepatitis, diarrheal diseases).
These problems affect the poor and vulnerable, and efforts to address them often intersect with livelihood challenges.
Middle-Class and Upper-Class Issues:
Environmental concerns such as air and water pollution, waste management, inadequate drainage, and unhealthy food.
Poor infrastructure and market regulations lead to these issues.
Road accidents, climate change, and chronic illnesses also affect both the middle class and the poor but may be less prioritized for the latter.
Curative Care Needs:
These are the most critical and controversial in public health.
The three levels of curative care are:
Primary Care: Relied upon by the poor and vulnerable through public health institutions due to proximity and affordability.
Secondary Care: Historically neglected and inadequate in terms of infrastructure and health professionals.
Tertiary Care: Focused on under the Pradhan Mantri Jan Arogya Yojana (PMJAY) as part of Ayushman Bharat.
History of Indian Public Health Policies
The National Rural Health Mission (NRHM) launched in 2005, followed by the National Health Mission (NHM) in 2013, aimed at strengthening public sector health care.
The NHM marked a shift from the National Health Policy of 2002, which emphasized the commercialization of healthcare.
The NHM revitalized the health system post the economic reforms of the 1990s, focusing on primary healthcare institutions and national health programs.
As of 2015, India had significant health infrastructure with 153,655 sub-centers, 25,308 primary health centers (PHCs), and 5,396 community health centers (CHCs).
The impetus created by NHM could have strengthened secondary and tertiary care but the focus shifted towards publicly funded health insurance schemes like PMJAY under Ayushman Bharat since 2018.
Publicly funded health insurance schemes (PFHI), like PMJAY, primarily benefit private healthcare providers.
In global standards, health insurance typically covers all healthcare costs, but in India, PMJAY covers only hospitalization expenses.
The outsourcing of secondary and tertiary care services to the private sector acknowledges the government’s failure to strengthen these levels of public sector healthcare.
Only a small portion of the population (12 crore households) is covered under PMJAY, leaving the rest to face commercialized healthcare expenses.
The conversion of sub-centers, PHCs, and CHCs into Health and Wellness Centres (HWC) in 2018 was controversial.
1,50,000 HWCs were announced, but these institutions already existed, as reported in rural health statistics of 2015.
Community health officers, with minimal medical training, were expected to provide curative care, weakening the traditional roles of these institutions.
This shift has led to a decline in public trust in healthcare institutions, both private (due to commercialization) and public (due to overcrowding and inadequate infrastructure).
Recent Changes and Public Health System Threats
The renaming of HWCs to "Ayushman Arogya Mandir" in 2023 raises questions, particularly about its relevance for non-Hindi-speaking populations and its association with secular health institutions.
Public health challenges in India are diverse, and addressing them across social groups is essential.
For the poor, basic primary and secondary care is the most critical need, but this has been neglected in favor of curative care schemes.
The government's failure to strengthen secondary and tertiary care has weakened the public health system, while the private sector continues to grow.
Primary healthcare institutions, once the foundation of India’s public health system, have been weakened, impacting their role in delivering preventive care and health programs at the grassroots level.
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