Health System Reforms

Introduce yourself

Reforming the healthcare system is essential to improving efficiency, access, and quality in any country. India faces many health problems, ranging from the burden of communicable and non-communicable (NCD) diseases, to its large population. In India, the health system is composed of various actors, such as government, private sectors, and nongovernmental organizations. Each one plays a key role in shaping healthcare. The article focuses on India’s health reforms, including the present landscape, the key reforms implemented, the challenges encountered, and what lies ahead.

The Health System in India: Current Landscape

1. Health System Structure

• Public HealthcareGovernment budgets are the primary source of funding for public health services. Primary healthcare centers, Community health centers and District hospitals are all part of a tier-structure that delivers the services.

• Private HealthcarePrivate sector is a major player in the healthcare industry, accounting for nearly 70 percent of all services. The private sector is known for its high quality services, but it also has higher prices. This can make the healthcare system inaccessible to those from lower socioeconomic backgrounds.

2. Key Health Indicators

• Maternal Mortality (MMR) RateIndia is making progress towards reducing MMR, but it still has a high ranking compared with global standards. In 2018, MMR was 113 for every 100,000 live births.

• Infant Mortality rate (IMR).By 2020, India’s IMR will be around 28 for every 1,000 births.

• Life ExpectancyIn India, the life expectancy has increased by 6.6 years from 2011 to 69.4 in 2021.

Key Health System Reforms of India

1. National Health Policy

• NHP 2017A comprehensive healthcare policy was introduced by the government with an aim to universal health care. This policy emphasizes the prevention of disease, promoting health and strengthening healthcare systems.

2. Ayushman Bharat

• Pradhan Mantri Jan Arogya Yojana (PM-JAY): Launched in 2018, this scheme provides health insurance coverage of up to ₹5 lakh per family per year for secondary and tertiary care hospitalization.

• Health and Wellness CentersThe Health and Wellness Centers initiative is aimed at turning existing sub-centres and PHCs in to Health and Wellness Centers. This will facilitate the delivery of primary healthcare.

3. Digital Health Initiatives

• National Digital Health MissionLaunched in 2019, NDHM aims for an integrated infrastructure of digital health, promoting digital health services. A digital health ecosystem is being created to link healthcare providers and recipients.

4. Strengthening Human Resources for Health

• Skill Development Initiatives: The government has undertaken various initiatives to educate and train health workers, focusing on increasing the psychiatrist-to-population ratio, which currently is about 0.3 doctors per 100,000 people.

• Community Health WorkersASHA, a program that empowers local women to provide essential healthcare in rural areas.

5. Infrastructure Development

• National Health MissionIn 2005 this mission was launched with the aim of strengthening healthcare systems, particularly in rural and unserved regions, through improved infrastructure and medical services.

6. The Private Sector: Regulation

• Clinical Establishments ActThe act regulates the quality of healthcare in private facilities, by requiring registration and adhering to specific guidelines.

• Cost RegulationDrug Price Control Order was introduced to help control the prices of essential treatments and medicines.

Health System Reform: Challenges and Opportunities

1. Public Health Funding

• Low-ExpenditureIndia invests only about 1,3% of its gross domestic product (GDP) in health care, which is well below the average global figure of 9,9%. The underfunding of health causes inadequate human and infrastructure resources.

2. Unfair Access to Healthcare

• Divide Between Urban and RuralThe rural and urban divide is evident in the accessibility of healthcare, as there are not enough medical professionals or facilities available to serve these areas.

• Economic BarriersHigh out of pocket costs (around 62% total health expenses) are a financial burden for families and can even lead to medical bankruptcy.

3. Qualitative Care

• The Variability of QualityThere are significant differences in the quality of health care between regions and sectors, as well as public and privatized healthcare.

4. Corruption and bureaucracy

• Red TapeThe bureaucratic obstacles and corruption in the healthcare sector can slow down reforms, and hamper progress.

5. The Resistance to Change

• Stakeholder oppositionMany stakeholders resist changes in policy, such as healthcare professionals and pharmaceutical companies.

What lies ahead

1. Spending on Health is Increasing

• Increase Public SpendingAccording to the NHP 2017 document, by 2025 healthcare spending should reach at least 2,5% of GDP.

2. Primary Healthcare Strengthening

• Integration of ServicesIt is important to integrate preventive, therapeutic, and rehabilitation services in primary care.

3. Focus on mental health

• Comprehensive Mental Health PolicyAssisting in the treatment of mental illness through improved policies and funding.

4. Utilizing Technology

• TelemedicineAdoption of telemedicine could bridge the divide between urban and rural areas. It can also improve access to experts.

• Data-Driven decision makingUse of health data analytics to improve policy formulation and allocation.

5. Engaging Communities

• Participants ApproachesParticipating communities in the planning and delivery of health care can lead to improved health outcomes.

The conclusion of the article is:

In India, reforming the healthcare system is essential to building an equitable system for providing care and meeting the varied needs of India’s diverse population. Although there have been significant improvements through the implementation of various policies and initiatives, it is still necessary to dedicate efforts towards achieving universal coverage. India’s health can be improved significantly with increased funding, an emphasis on primary care, and enhanced engagement of the community.

FAQ

1. What are Ayushman Bharat’s main goals?

Ayushman Bharat provides financial security to families through health insurance. It aims to lower out-ofpocket expenses and increase access to healthcare.

2. What are the benefits of the National Digital Health Mission for patients?

The NDHM provides seamless access for citizens to the health system by creating a unique Health ID.

3. What are the challenges facing Indian Healthcare today?

In addition to low spending on public healthcare, there are also issues such as unequal access, quality variations, corruption and the resistance of stakeholders to reform.

4. How can the use of technology improve health care in India?

Technologies such as telemedicine, can increase access to healthcare for people in rural areas. Moreover, health analytics and digital health records can improve services.

5. What is the role of community health workers in India’s healthcare?

ASHAs are community health workers who provide vital health services to rural communities. They facilitate access to healthcare, promote health education and connect the local communities with resources.

This article provides an overview of the Indian health system reforms, including their impact, present efforts and future challenges.