Citizen Engagement in Health Governance: From 'Beneficiaries' to 'Partners'
UPSC Relevance
Prelims: Indian Polity & Governance (Participatory Governance), Social Justice & Health (Schemes like National Health Mission - NHM, role of VHSNCs, Rogi Kalyan Samitis).
Mains:
GS Paper 2: Issues relating to development and management of Social Sector/Services relating to Health; Role of civil society, NGOs, and other stakeholders in development processes; Important aspects of governance, transparency and accountability.
Key Highlights from the News
Background: Schemes like 'Makkalai Thedi Maruthuvam' in Tamil Nadu and 'Gruha Arogya' in Karnataka bring healthcare to people's doorsteps. However, the article raises the question of how much public participation there is in decisions regarding health governance.
Importance of Citizen Participation: Public participation is essential for upholding democratic values, ensuring accountability in health systems, reducing corruption, and improving the quality of health services.
Existing Mechanisms:
The National Rural Health Mission (NRHM), in 2005, established mechanisms for public participation at the village level through Village Health Sanitation and Nutrition Committees (VHSNCs) and at the hospital level through Rogi Kalyan Samitis (RKS).
Main Problems:
Mindset Problem: Policymakers and health workers view people as passive "beneficiaries" rather than partners in the health system. They do not have the perspective that people are "rights-holders."
Systemic Flaws: Committees like VHSNCs are often not formed in many places or are dysfunctional. Social hierarchies affect the functioning of these committees.
Medical Dominance: Health governance is primarily controlled by doctors. Promotions are often based on seniority rather than expertise in public health.
Proposed Solution:
A "two-pronged approach" is needed:
Empowering communities: Provide information about health rights and governance systems.
Sensitize health system actors: Train them to view people as partners..
COMMENTS