In a crucial domain like the public healthcare system, the Indian State should play a vital role to contain the adverse impact of marketisation of the system. Suggest some measures through which the State can enhance the reach of public healthcare at the grassroots level.

Introduction

The public healthcare system in India faces challenges such as inadequate infrastructure, low public spending (1.28% of GDP in 2023), and the growing marketisation of healthcare, which often leads to inequities in access and affordability. The State, as a welfare provider, must play a pivotal role in ensuring universal healthcare access, especially at the grassroots level, to mitigate these challenges and uphold Article 21 (Right to Life) and DPSP (Article 47).

Key Challenges in Public Healthcare at the Grassroots Level

• Low public expenditure: India spends only 1.28% of GDP on healthcare, far below the WHO-recommended 5%.
• Urban-rural divide: 70% of healthcare infrastructure is concentrated in urban areas, while 65% of the population resides in rural areas.
• Out-of-pocket expenditure (OOPE): Over 60% of healthcare costs are borne by individuals, pushing millions into poverty annually.
• Shortage of human resources: India has a doctor-patient ratio of 1:834, below the WHO norm of 1:1000.
• Marketisation: Private healthcare dominates, often prioritizing profit over patient welfare, leading to exclusion of the poor.

Value Addition Block — Key Dimensions of Grassroots Healthcare Challenges

Measures to Enhance Public Healthcare at the Grassroots Level

1. Strengthening Primary Healthcare Infrastructure

• Expand Health and Wellness Centres (HWCs): Scale up the target of 1.5 lakh HWCs under Ayushman Bharat to ensure comprehensive primary care.
• Mobile Medical Units (MMUs): Deploy MMUs in remote and tribal areas to provide last-mile healthcare access.
• Upgrade Sub-Centres and PHCs: Ensure 24x7 functionality with adequate staff, medicines, and diagnostic facilities.

2. Increasing Public Health Expenditure

• Raise spending to 2.5% of GDP: As per the National Health Policy, 2017, to reduce OOPE and improve service delivery.
• Focus on preventive care: Allocate funds for immunization, sanitation, and nutrition programs to reduce disease burden.

3. Human Resource Development

• Recruit and train healthcare workers: Increase the number of doctors, nurses, and ASHAs, especially in underserved areas.
• Incentivize rural postings: Provide financial and career incentives to healthcare professionals for serving in rural and remote areas.
• Skill development programs: Train community health workers in basic diagnostics and treatment.

4. Regulating Private Healthcare

• Price capping: Regulate the cost of essential medicines, diagnostics, and treatments to make healthcare affordable.
• Public-private partnerships (PPPs): Collaborate with private players to expand healthcare infrastructure while ensuring accountability.
• Strengthen regulatory frameworks: Enforce standards for quality and ethics in private healthcare.

5. Leveraging Technology

• Telemedicine platforms: Expand initiatives like e-Sanjeevani to provide virtual consultations in rural areas.
• Digital health records: Implement the National Digital Health Mission (NDHM) to streamline patient data and improve service delivery.
• AI and data analytics: Use technology for disease surveillance and targeted interventions.

6. Community Participation and Awareness

• Health literacy campaigns: Educate communities about preventive healthcare, hygiene, and nutrition.
• Empower local governance: Involve Panchayati Raj Institutions (PRIs) in planning and monitoring healthcare services.
• Strengthen ASHA and ANM networks: Enhance their role in maternal and child health, immunization, and awareness programs.

Way Forward

• Adopt a rights-based approach: Recognize healthcare as a fundamental right and ensure universal access.
• Focus on equity: Prioritize vulnerable groups such as women, children, and tribal populations.
• Integrated approach: Align healthcare initiatives with SDG 3 (Good Health and Well-being) and other social determinants like education, water, and sanitation.

Conclusion

A robust public healthcare system is essential for achieving universal health coverage (UHC) and reducing inequalities. By enhancing grassroots healthcare through increased public investment, technological integration, and community participation, the State can fulfill its constitutional mandate of ensuring the right to health for all citizens, especially the marginalized.