Relevance: GS-2: Issues relating to development and management of Social Sector/Services relating to Health, Government policies, and interventions for development in various sectors.

Key Phrases: Bhore Committee Report, Kartar Singh Committee Report, National Rural Health Mission (NRHM), Ayushman Bharat Mission, Indian Public Health Standards, Kerala Model of Healthcare System, Effective Primary Healthcare System

Context:

• The Covid pandemic has once again highlighted the need for an effective primary healthcare system.
• The overcrowding of hospitals with anxious patients and stressed families has brought to the fore the need for family doctors and a resilient primary health system.

Various Interventions for reforming the healthcare sector:

• The Bhore Committee Report of 1946, the Kartar Singh Committee Report of 1973, the National Rural Health Mission (NRHM) of 2005, and the Ayushman Bharat Mission of 2019 are significant landmarks in reforming the health sector.

National Rural Health Mission (NRHM):

• The NRHM, now under National Health Mission is an initiative undertaken by the government of India to address the health needs of under-served rural areas.
• Launched on 12 April 2005, the NRHM was initially tasked with addressing the health needs of 18 states that had been identified as having weak public health indicators.
• The NRHM was a game changer in reforming the healthcare system by publishing the Indian Public Health Standards (IPHS) which set the standards for physical infrastructure, human resources and service delivery.
• It made a three-fold increase in budget.

Key Achievements of NRHM:

• Institutional deliveries went up from 41 percent in 2005 to 89 percent in 2021.
• The maternal mortality ratio went down from 407 per one lakh women in 2,000 to 113 per one lakh women in 2021.
• The infant mortality ratio reduced from 58/1,000 live births in 2005 to about 28/1,000 live births in 2021.
• There has been increased availability of drugs, diagnostics, and doctors.
• The healthcare system has registered an impressive improvement in states like Bihar and UP.

What are the issues faced by the NRHM?

• The primary healthcare system in India continues to be plagued with gaps and deficiencies.
• The current facilities serve two to ten times the population they are designed to serve.
• Rarely 10% of the present public health facilities match up to the standard of IPHS.
• Public spending on healthcare is barely 1.1 percent of the GDP.
• Wavering political support for primary care.

Healthcare System in India:

• The system today comprises a multi-tiered structure with a 30-bed community health centre which is operated by four specialists at the block level and a community worker at the village level wherein the services cover 12 diseases/needs.

Kerala Model of Healthcare System:

• The state has reformed its healthcare system based on the UK’s GP (general practitioners) system.
• A series of coordinated interventions were launched which included:
  • Changing timings
  • Redesigning the centre and equipping them with patient and people-friendly facilities
  • Providing intensive training to the staff to undertake new functions and responsibilities
  • Improving diagnostic facilities
  • Computerising data to make processes paperless
  • Ensuring post-hospitalisation follow-ups.
• The comprehensive approach has been enabled by a tripartite partnership between the state’s health department, women’s collectives, and community-level bodies.
• Kerala appears to be the only state to revamp its primary healthcare system along the foundational principles of comprehensive primary care which includes a community-anchored delivery system, a continuum of care, and patient-centred, protocol-driven, evidence-based treatment.
• It focused on assessing the demographic and epidemiological ground realities and acknowledging that the 70-year-old PHC structure did not have the institutional capacity to manage chronic diseases and thus, treated them by following a holistic approach.
• The Primary health centers in Kerala provide a wide range of drugs and medical services, including nebuliser treatment for asthma patients and providing palliative care at home.

Way Forward:

1. For Kerala:
   • The state needs to deepen its reforms and strengthen the accountability framework of the doctors, paramedics, and frontline workers.
   • These interventions may help in reducing the insulin dependence of a diabetic through sound case management and effective counseling on lifestyle changes i.e. proper medications, diet, exercise, and yoga.
   • This proactive primary healthcare system can help early in the diagnosis, reduce hospitalisations and bring down severe morbidity and mortality.
2. For other states:
   • Health systems need to be reformed according to the state’s disease burden as the interstate differentials in morbidity patterns are wide.
   • Therefore, a National policy is needed which is flexible and allows for differential strategies as a single system may not be apt for the entire country.
   • The states and the districts need to be provided with the space for innovation to plan, design, and implement primary care in accordance with local needs.
   • The Centre ought to accept the principles of flexibility and decentralization and its role should be limited to measuring outcomes.

Conclusion:

• Reforming the health system needs resetting the approach, changing the design along with increased financial resources.
• It’s time to speed up the effort to establish a sound primary healthcare system, which can prevent illness and provide healing .
• There is an urgency to make healthcare services and service providers more transparent operationally.
• Increasing the Public-Private Partnerships can help to increase the last-mile reach of healthcare.

Source: Indian Express

Mains Question:

Q. What are the various issues faced by the healthcare system in India? Suggest the way forward in order to ensure the last mile reach of healthcare services. (250 words).