Context: The neglect of Primary Health care (PHC) systems under AB-PMJAY and focus on targeted interventions instead of a comprehensive agenda to tackle malnutrition call for an urgent overhaul of the healthcare sector in India.
Relevance of the Topic: Mains: Healthcare in India- Nutrition, Insurance- challenges, way forward
Health for All
- India is committed to the principle of 'Health for All' under WHO’s Universal Health Coverage (UHC) framework. This framework prioritises Primary Health Care (PHC) and aims to reduce out-of-pocket expenditure (OOPE).
- Initiatives like Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) aim to provide financial protection and reduce OOPE. However, there are growing concerns regarding neglect of primary healthcare (PHCs) and increasing reliance on market-driven private healthcare.
Present Healthcare Landscape in India
- Malnutrition: India has one of the highest rates of malnourished children and anaemic women. According to National Family Health Survey-5:
- 36% of children under five are stunted.
- Only 11% of children aged 6-23 months are breastfed and receive an adequate diet.
- 57% of women in the 15-49 age group are anaemic.
- Non-communicable diseases (NCDs) such as diabetes, hypertension, and lifestyle-induced diseases are on the rise, highlighting another dimension of under-nutrition.
- 24% of women and 23% of men are overweight or obese.
- 14% of the population uses medication for diabetes.
- Skewed Health Budget: Budget 2025 places much emphasis on medical digital infrastructure and expanding medical education over strengthening primary healthcare.
- Privatisation in Insurance: The government has increased Foreign Direct Investment (FDI) cap in the insurance sector aims to boost insurance penetration. While it attracts more private players, it further intensifies privatisation of healthcare services.
Challenges in Healthcare
1. Problems with current nutrition schemes (Narrow Focus):
- Poshan 2.0 fails to recognise the broader national nutrition challenge confining efforts to certain geographic regions and population segments.
- Current policies predominantly focus on malnutrition among women and children, leaving out other vulnerable groups such as men, senior citizens, and individuals suffering from non-communicable diseases (NCDs) related to diet.
- The policies do not address the broader aspects of under-nutrition, such as insufficient access to nutritionally rich food or lifestyle-induced diseases like obesity and diabetes.
2. Inadequate Infrastructure:
- Rural areas may have a higher concentration of Health and Wellness Centres (HWCs), but urban areas face a lack of sufficient coverage.
- Current services at HWCs (including nutrition advice for pregnant women, lactating women, children, adolescents and the elderly) are not systematically implemented and not consistently available.
3. Cultural and Socio-economic barriers: Dietary habits are influenced by culture and caste dynamics which complicate the design and implementation of nutrition interventions leading to fragmented approaches. E.g., Resistance to eggs in mid day meal schemes.
4. Overpriced drugs: Private firms have invested heavily in R&D for new drugs, especially for secondary and tertiary care; hence, the price of patented drugs is passed on to consumers.
5. Healthcare policies-related challenges:
- Concerns with Ayushman Bharat: PMJAY excludes outpatient care. As people requiring only outpatient care outnumber those requiring hospitalisation, the majority have to rely on costly private facilities for outpatient care.
- Low Health Budget: Despite the significant increase in government expenditure on Health, it is still below the target of National Health Policy (2017)- 2.5% of GDP. The National Health Mission, essential for grassroots healthcare, receives a declining share in the Health budget.
- Insurance illiteracy: Migrant workers and the non-literate sections of the population face challenges in accessing insurance services.
- Health security for Informal workers: Informal workforce remains without adequate health security due to the lack of universal coverage.
- Outdated data from the 2011 Census and the 2020-21 Periodic Labour Force Survey hinders effective resource allocation and limits the efficiency of social protection schemes.
As a result, a significant portion of healthcare expenditure in India is from out-of-pocket expenditure (47.1% in 2019-20).
Way Forward
- Comprehensive National Nutrition Strategy beyond maternal and child malnutrition. Identifying the nutritional needs of men, senior citizens, and people suffering from lifestyle diseases and a wider range of deficiencies.
- Locally available nutrient-dense, and low-cost food options can ensure access to nutritious food.
- Strengthen Health and Wellness Centres. HWCs must be more widely distributed, particularly in urban areas, equipped with a comprehensive set of nutrition services for all age groups with dedicated nutrition staff.
- Public health education campaigns focusing on dietary habits and lifestyle changes to combat the rising incidence of NCDs.
- Strengthen Primary Health Care to expand access to affordable and preventive healthcare at the grassroots level. Allocate more funds to National Health Mission (NHM).
- Address Informal workers’ health security to achieve universal health coverage. E.g., PMJAY is expanded to gig workers.
- Regular surveys and Census updates to track the health needs of the population and for better allocation of resources.
To move India towards UHC, the government, civil society, health-care providers, and communities need to work together.