Transformation of Public Health in India
The nature of public health globally has evolved, influenced by economic expansion and modern lifestyles. Modern challenges include:
- Antimicrobial resistance
- Chronic non-communicable diseases (NCDs)
- Zoonotic diseases
- Mental health illnesses
NCDs account for over 60% of global deaths, estimated to rise by 17% in the next decade. A new public health system is needed that views health as a dynamic interaction between the environment, socioeconomic factors, and health behaviors.
Ayushman Bharat Scheme
Launched in India's 2018 budget, the Ayushman Bharat scheme aims to strengthen the public health system with a budget of approximately US $8.4 billion. It includes:
- Pradhan Mantri - Jan Arogya Yojana (PM-JAY): Provides financial coverage of ₹5 lakh to BPL cardholders and senior citizens.
- Ayushman Arogya Mandir (AAM): Focuses on primary health care through Health and Wellness Centres (HWCs) offering comprehensive care.
- Pradhan Mantri Ayushman Bharat Health Infrastructure Mission (PM-ABHIM): Launched with ₹64,180 crore to enhance health infrastructure.
The scheme aims to improve survival and well-being while protecting against catastrophic healthcare expenditure (CHO), defined by WHO as out-of-pocket payments exceeding 40% of the capacity to pay for healthcare.
Current Public Health System and Challenges
India's public health faces challenges like user experience and trust. Trust impacts health-seeking behavior and healthcare utilization. Despite improvements at the primary level through public funding and initiatives like the National Health Mission, blind spots remain.
As of November 2024, 1,75,338 Ayushman Arogya Mandirs are operational with 350 crore consultations. The National Health Accounts report shows a reduction in per capita out-of-pocket health expenditure (OOPHE) from 64.2% in 2013-14 to 39.4% in 2021-22. However, absolute OOPHE figures have increased annually.
Enhancing Public Health Visibility and Quality
Public health facilities need increased visibility and trust. National Quality Assurance Standards (NQAS) were introduced to bring global standards to public health facilities. As of November 2024, 17,017 facilities are NQAS certified.
Emphasizing high-quality, trusted, and context-responsive health systems is crucial. The Indian Public Health Standards (IPHS) of 2007 need updating to prioritize international standards.
Future Directions
To increase trust and efficiency, capturing user experience and making the data public is recommended. This could aid in managing chronic and complex diseases requiring comprehensive care.
Local governments should prioritize facility locations with public transport access, especially in urban areas. The National Digital Health Mission could assist people in locating public health facilities via GPS.
Finally, fostering trust in government health services is essential to protect citizens from catastrophic health expenditures.