Breaking unhealthy silos
Mains Paper 4: Governance
Prelims level: NRHM
Mains level: Issues relating to development and management of Social
Sector/Services relating to Health, Education, Human Resources.
- The (SDG-3) pertains to healthcare “Ensure healthy lives and
promote well-being for all at all ages”.
- This goal is important for several reasons.
- Health indicators and figures on healthcare access present a
picture of widespread inequality.
- The pharmaceutical industry and medical diagnostic procedures
compromise environmental integrity and public health systems do not address
the health impacts of environmental pollution.
- While under-nutrition and communicable diseases persist,
noncommunicable diseases (NCD) such as cancers, hypertension, diabetes,
respiratory problems and injuries are rising.
- Universal Health Coverage (UHC) has been adopted as the strategy
to attain SDG-3.
- The Astana Declaration underscored the importance of Primary
Health Care (PHC) as an essential complement to UHC.
- UHC concentrates on ensuring healthcare access through medical
insurance “coverage” in order to “prevent catastrophic medical
The Astana declaration
- The Astana declaration (2018) attempts to integrate the two
approaches. “We will apply knowledge, including scientific as well as
traditional knowledge, to strengthen PHC, improve health outcomes and ensure
access for all people to the right care at the right time and at the most
appropriate level of care, respecting their rights, needs, dignity and
autonomy,” the declaration states.
- However, what the Astana Declaration leaves unsaid is a matter of
- It is silent on the socio-economic and political conditions
(international and national) that lead to malnutrition and ill-health.
- It does not talk of the complicity of private sector healthcare
outfits and the pharmaceutical and insurance industries in creating the
problem of unaffordability.
- UHC seems to be premised on the belief that increasing access to
the “doctor-hospital-centred healthcare” is the solution to the crisis.
- The principles of the PHC approach of the Alma Ata declaration
(1978) such as healthcare “closest to home” and “appropriate technology”
that is effective, safe, cheap, and simple to use, need to be applied to the
healthcare system as a whole.
- People’s experiences, knowledge and practices need to be respected
if we are to shift to patient-centred and community-centred healthcare.
- Binaries of “scientific” versus “traditional” need to be given up
by acknowledging the validity and limitations of various knowledge systems.
- In India, the UHC-PHC complement is embodied in the Ayushman
Bharat scheme the Pradhan Mantri Jan Aarogya Yojana (PMJY) reflects the UHC
model, the health and wellness centres reflect the PHC component at the
Significance of NRHM
- This is a shift from the earlier strategy for strengthening public
healthcare system, reflected in the National Rural Health Mission (NRHM),
2005-2012 — later the National Health Mission with incorporation of the
National Urban Health Mission.
- NRHM addressed primary and secondary levels, leading to an
increase in public health expenditure, from 17 per cent of total health
expenditure in 2004-05 to 30 per cent by 2014.
- This was no mean achievement, especially at a time when
privatisation was the larger policy trend.
- Huge sums are being promised for insurance against hospitalization
under the PMJAY.
- However, evidence from the Rashtriya Swasthya Bima Yojana (RSBY)
shows that such insurance schemes distort health provider behaviour, add
unnecessary transaction costs and on aggregate do not reduce out of pocket
expenditures on health.
- Thus there is no option but to strengthen public services.
- The Health and Wellness Centres bring focus on to noncommunicable
diseases (NCDs), in addition to the ongoing communicable disease control
programmes and maternal and child health programmes.
- The ambit of services provided has increased and public services
at the primary level have been strengthened.
- However, this is not in sync with the broad SDG of improved
- Attaining this goal requires that the environmental, social, and
economic conditions are made conducive to health. Economic, agricultural,
industrial, rural and urban development policies should all keep people’s
health as their central goal.
- AYUSH practitioners — who have taken “bridge’ courses” — will be
posted at the health and wellness centres to screen NCDs and implement
- The PHC-infused UHC provides a window of opportunity for
revisioning and creating sustainable and empowering healthcare.
- Will we as a country make use of the opportunity Astana provides,
or continue to be caught in the trap of over-medicalised commercialised
Q.1) Accredited Social Health Activist (ASHA) workers are a central
feature of National Rural Health Mission (NRHM). Consider the following
statements in this context:
1. ASHA must be a woman resident of a village.
2. ASHAs are selected by and are accountable to the gram panchayats only.
3. ASHAs are given performance based incentives.
Which of the statements given above is/are correct?
(a) 1 only
(b) 2 and 3 only
(c) 1 and 3 only
(d) 1, 2 and 3
Q.1) Health infrastructure is an important indicator for understanding
the health care delivery provisions and welfare mechanism in a country.
Critically analyze, in the light of the findings of National Health Profile.