QUESTION : Make a list of  issues within  the public healthcare system in India and how can these issues be addressed in a time bound manner? Explain. 
Healthcare System of India  
The new Health Minister needs to focus on the core lessons from the pandemic and rebuild trust in public health . For any population, the availability of functional public health systems is literally a question of life and death. 
• COVID-19 case fatality rates are 0.48% for Kerala and 2.04% for Maharashtra, despite both states having similar per capita gross State domestic product (GSDP).
• This implies that on average, a COVID-19 patient in Maharashtra has been over four times more likely to die when compared to one in Kerala.
• Kerala has per capita two and a half times more government doctors, and an equally higher proportion of government hospital beds when compared to Maharashtra, 
• Kerala fund allocation on public health per capita is over one and half times higher than that of Maharashtra.
• Despite Maharashtra having a large private health-care sector, its weak public health system has proved to be a critical deficiency. 
• Articles 39, 41, 42 and 47 in the Directive Principles of State Policy (DPSP) contain provisions regarding Health.
• Article 21 provides for the right to life and personal liberty and is a fundamental right. 
 Lack of Primary Healthcare Services: The existing public primary health care model in the country is limited in scope. 
o Even where there is a well-functioning public primary health centre, only services related to pregnancy care, limited childcare and certain services related to national health programmes are provided.
o This represents only 15% of all morbidities for which people seek care.
 Supply-Side Deficiencies: Poor health management skills and lack of appropriate training and supportive supervision for health workers prevent delivery of the desired quality of health services.
 Inadequate Funding: Expenditure on public health funding has been consistently low in India (approximately 1.3% of GDP). As per OECD, India’s total out-of-pocket expenditure is around 2.3 % of GDP.
 Overlapping Jurisdiction: There is no single authority responsible for public health that is legally empowered to issue guidelines and enforce compliance of the health standards.
 Sub-optimal Public Health System: Due to this, it is challenging to tackle Non-communicable Diseases, which is all about prevention and early detection. 
o It diminishes preparedness and effective management for new and emerging threats such as pandemic like Covid-19. 
• Arrest Decline in Funding: Since 2017-18, Union government allocations for the National Health Mission have declined in real terms. Central allocation for the National Urban Health Mission is ₹1,000 crore, which amounts to less than ₹2 per month per urban Indian. This situation must change.
• Preventing further privatisation of the health sector: Proposals for handing over public hospitals to private operators under the ‘Viability Gap Funding’ would lead to steep increase in healthcare costs.
• Regulation of private hospitals: Learning from stark market failures during the COVID-19 pandemic, comprehensive regulation of private health care in public interest now must be a critical agenda of government.
• Effective implementation of CEA: Clinical Establishments (Registration and Regulation) Act is not effectively implemented due to a major delay in notification of central minimum standards, and failure to develop the central framework for regulation of rates. 
• Improving infrastructure: There is a need of improvising the infrastructure of public hospitals which have a lot of burden due to the high population in India.
• Efficiency enhancement: More medical personnel must be recruited to enhance the capabilities and efficiency of the sector.
• Technology utilisation: Technologies must be used to connect the dots in the health system. Medical devices in hospitals/ clinics, mobile care applications, wearables, and sensors are some forms of technology that should be added in this sector.
• Awareness: People should be made aware of early detection and preventive care. It would help them in saving pocket expenditure also. 
Pandemics such as Covid-19 starkly remind us that public health systems are core social institutions in any society. The government has made several efforts to address the shortfall in the public health system through the schemes like the National Medical Commission (NMC) Act, 2019 PM Bhartiya Janaushadhi Pariyojna, PM- Jan Arogya Yojna, etc.

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