HOW TO GENERATE DIMENSIONS

MISTAKES THAT SHOULD BE AVOIDED:-

PHC SHC secodary
❖ Inadequate- quantity and quality-rural focus only
❖ Mainly deals with communicable diseases, however Urban oriented
there is increase in burden for non-communicable Accessibility-80% doctors, 75% dispensaries, 60%
diseases hospitals-urban areas
❖ No focus on diagnosis and prevention Poor PPP
❖ Only 'sick-care', or mother and child care oriented Weak PHC and non-reachability
Non-integration of Ayush Poor governance and no accountability mechanism
❖ Presence of Quarks THE
Oriented mainly in urban areas, regional disparities
Non medical expand
High OOPE
No standardization or evidence based guidelines
Private sector oriented(2/3)
Poor spending of the govt in this sector,
No need to remember all
of them just 5-6 enough
1. Public expenditure on health is merely 1.3% of GDP. National Health Policy 2017 set a target
of 2.5% of GDP. ?????
In the Economic Survey of 2022, India’s public expenditure on healthcare stood at 2.1% of GDP
in 2021-22 against 1.8% in 2020-21 and 1.3% in 2019-20.
2. India has one-of-the highest level of Out-Of-Pocket Expenditures (OOPE) (around 65% of
total health expenditure) contributing directly to the high incidence of catastrophic
expenditures and poverty [As per Economic Survey 2020].
3. More than 80% of India’s population is uninsured [As per 71st round of NSSO].
4. Low doctor-population ratio of 0.7 per 1000 population, while WHO recommends at least 1
doctor per 1000 population.
5. Low nurse-population ratio of 1.7 per 1000. WHO recommends at least 3 nurses per 1000
population.
6. Rural-urban divide - the distribution of health workers is uneven between urban and rural
areas. Rural areas with nearly 71% of India's population have only 36% of health workers.
7. Government medical colleges in the country produce 50 per cent of all doctors in India every
year, but nearly 80 per cent of them work in the private sector.
8. Of all healthcare spending, only 7% is spent on preventive healthcare, while more than 80%
is spent on treatment and cure
Health & Law
Presently, health is under the state list of the 7th Schedule of the Indian Constitution.
Suggestions by 15th finance commission chairman NK Singh
❑ shift to concurrent list under the constitution.
❑ Increased government spending on health to 2.5% of GDP by 2025.
❑ Primary health care should be a fundamental commitment of all states in particular and
should be located at least two third of health spending.
❑ Forming an all India Medical and Health Service.
❑ A health sector specific development financial institution is much needed.

RIGHT TO HEALTH
•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.
•Alma ata declaration
Ayushman Bharat seeks to provide for Universal health coverage (UHC) by
adopting two approaches Creation of
1. 1.5 lakh Health and Wellness centres (HWCs) and
2. Pradhan Mantri Jan Arogya Yojana (PM-JAY).

The PM-JAY aims at providing a health insurance cover of Rs. 5 lakhs per family
per year for secondary and tertiary care hospitalization.
- Coverage: 50 crore people who belong to bottom 40% of India’s population.
Beneficiaries are identified through socio-economic caste census (SECC).
 CHALLENGES
•Inadequate Access:
• Inadequate access to basic healthcare services such as shortage of medical professionals, a lack of quality assurance,
insufficient health spending, and, most significantly, insufficient research funding.
• One of the major concerns is the administrations' insufficient financial allocation.
•Low Budget:
• India’s public expenditure on healthcare is only 2.1% of GDP in 2021-22 while Japan, Canada and France spend about 10% of
their GDP on public healthcare.
• Even neighbouring countries like Bangladesh and Pakistan have over 3% of their GDP going towards the public
healthcare system.
•Lack of Preventive Care:
• Preventive care is undervalued in India, despite the fact that it has been shown to be quite beneficial in alleviating a variety
of difficulties for patients in terms of unhappiness and financial losses.
•Lack of Medical Research:
• In India, R&D and cutting-edge technology-led new projects receive little attention.
•Policymaking:
• Policymaking is undoubtedly crucial in providing effective and efficient healthcare services. In India, the issue is one of
supply rather than demand, and policymaking can help.
•Shortage in Professionals:
• In India, there is a shortage of doctors, nurses, and other healthcare professionals.
• According to a study presented in Parliament by a minister, India is short 600,000 doctors.
•Paucity of Resources:
• Doctors work in extreme conditions ranging from overcrowded out-patient departments, inadequate staff, medicines and
infrastructure.
Strong role of Private players:
• Approximately 70 per cent of the healthcare services in India are provided by
private players. If private healthcare crumbles due to economic constraints or other
factors, India’s entire healthcare system can crumble.
• Over 70 per cent of the total healthcare expenditure is accounted for by the
private sector.
• However, Private hospitals don’t have adequate presence in Tier-2 and Tier-3 cities
and there is a trend towards super specialisation in Tier-1 cities.
• lack of transparency and unethical practices in the private sector.
• Lack of level playing field between the public and private hospitals has been a
major concern as public hospitals would continue receiving budgetary support. This
would dissuade the private players from actively participating in Governmental
scheme.
ISSUES IN URBAN HEALTHCARE
•Rural-urban disparity: Until recently, Union government mostly focused on rural
healthcare. Ex: expenditure on urban areas was ₹850 crore in 2019-20, compared to
nearly ₹30,000 crore for rural.
•Lack of government primary and preventive health infrastructure: Against a norm-
based target of 9,072 urban primary health centres (UPHCs), only 5,190 are operational.
•Most states do not have urban sub-centres (SCs), people’s first point of access for
healthcare services. There are only 3,000 urban SCs compared to over 150,000 in rural
areas.
•Urban areas also suffer from ‘over-hospitalization’ of basic care, ideally done in clinics.
•Lack of devolution of functions by state government and inadequate role
clarity among various health-related agencies
•Poor financial condition of ULBs, and low priority accorded to health.
•ISSUES IN RURAL HEALTHCARE
•Only one allopathic doctor is available for every 10,000 people and one state run
hospital is available for 90,000 people.
•Innocent and illiterate patients or their relatives are exploited, and they are allowed to
know their rights.
•Most of the centres are run by unskilled or semi-skilled paramedics and doctor in the
rural setup is rarely available.
•Patients when in emergency sent to the tertiary care hospital where they get more
confused and get easily cheated by a group of health workers and middlemen.
•Non-availability of basic drugs is a persistent problem of India’s rural healthcare.
•In many rural hospitals, the number of nurses is much less than required.
•Social determinants of health (SDH) approach: Over the last decade, the Government
has been silently working on translating the SDH framework into practice, with key
interventions in the areas of:
• nutrition (National Nutrition Mission)
• drinking water (Har Ghar Jal)
• indoor air pollution (Ujjwala Yojna)
• sanitation (Swachh Bharat)
• road access (Gram Sadak Yojana)
• gender (Beti Bachao Beti Padhao)
What measures are required in the sector?
•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.
•Focus on private hospitals: Private hospitals must be encouraged by the
government because their contribution is important. Private sector also needs to
participate because the challenges are significant and these cannot be resolved only
by the government alone.
•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.
•There is an immediate need to increase the public spending to 2.5% of GDP, despite that being lower than global
average of 5.4%.
•The achievement of a distress-free and comprehensive wellness system for all hinges on the performance of health
and wellness centers as they will be instrumental in reducing the greater burden of out-of-pocket expenditure on
health.
•there is a need to depart from the current trend of erratic and insufficient increases in health spending and make
substantial and sustained investments in public health over the next decade.
•A National Health Regulatory and Development Framework needs to be made for improving the quality (for
example registration of health practitioners), performance, equity, efficacy and accountability of healthcare delivery
across the country.
•Increase the Public-Private Partnerships to increase the last-mile reach of healthcare.
•Generic drugs and Jan Aushadi Kendras should be increased to make medicines affordable and reduce the major
component of Out of Pocket Expenditure.
•The government’s National Innovation Council, which is mandated to provide a platform for collaboration amongst
healthcare domain experts, stakeholders and key participants, should encourage a culture of innovation in India and
help develop policy on innovations that will focus on an Indian model for inclusive growth.
•India should take cue from other developing countries like Thailand to work towards providing Universal Health
Coverage. UHC includes three components: Population coverage, disease coverage and cost coverage.
•Leveraging the benefits of Information Technology like computer and mobile-phone based e-health and m-health
initiatives to improve quality of healthcare service delivery. Start-ups are investing in healthcare sector from process
automation to diagnostics to low-cost innovations. Policy and regulatory support should be provided to make
healthcare accessible and affordable
Universal Health Coverage Universal health coverage include the following
components:
❖ To ensure health services for all Indian citizens in any part of the country,
regardless of income level, social status, gender, caste or religion
❖ Health services must be affordable, accountable and of high quality
❖UHC also should be Promotive, preventive, curative and rehabilitative
services should address the wider determinants of health delivered to
individuals and populations
❖ Government must the guarantor and enabler, although not necessarily the
only provider of health and related services
UHC must meet the objectives of improving coverage, expanding access,
controlling cost, raising quality, and strengthening accountability. Challenges to
achieve UHC are:
❖ Public sector is severely underfunded.
❖ Private sector is growing but their rising high cost healthcare service is
problematic.
❖ Our country is also facing serious issues of inadequate quality and coverage.
❖ Ineffective regulation is a concerned area.
❖ Combining public and private providers effectively for meeting UHC goals in a
manner that avoids perverse incentives, reduces provider induced demand.
❖ Integrating different types and levels of services—public health and clinical;
preventive and promotive interventions along with primary, secondary, and
tertiary clinical care.
National Health Mission After the success of the National Rural health Mission, the National Health
Mission (NHM) was announced in 2012 covering all the villages and towns in the country. The National
Health mission has two sub-missions:
1. National Rural Health Mission
2. National Urban Health Mission
The core principles of NHM are:
Universal Coverage
The NHM shall extend all over the country, both in urban and rural areas and promote universal access to a continuum of
cashless, health services from primary to tertiary care.
Achieving Quality Standards
Standards would include the complete range of conditions, covering emergency, prevention and management of
Communicable and Non-Communicable diseases incorporating essential medicines, and Essential and Emergency Surgical
Care (EESC). The objective would be to achieve a minimum norm of 500 beds per 10 lakh population in an average district. o
For ensuring access to health care among under-served populations, the existing Mobile Medical units would be expanded to
have a presence in each CHC.
Continuum of Care The linkages between different health facilities would be built so that all health care facilities in a region
are organically linked with each other, with medical colleges providing the broad vision, leadership and opportunities for skill
up-gradation. The potential offered by tele-medicine for remote diagnostics, monitoring and case management needs to be
fully realised.
Decentralised Planning o A key element of the new NHM is that it would provide considerable flexibility to States and
Districts to plan for measures to promote health and address the health problems that they face. New health facilities would
not be set up on a rigid, population based norm, but would aim to be accessible to populations in remote locations and within
a defined time period.
AYUSH AYUSH is the non-allopathic medical systems in India comprising of Ayurveda, Yoga and
Naturopathy, Unani, Siddha and Homoeopathy.
Benefits of AYUSH system are:
❑ It addresses gaps in health services.
❑ It provides low cost services in far-flung areas.
❑ AYUSH can provide best care to elderly.
❑ Problem of tobacco and drug abuse can be tackled by AYUSH especially through Yoga.
❑ Useful in lifestyle diseases like diabetes and hypertension.
❑ Large part of the population prefers AYUSH as it is perceived to have lower side effects,
costs and considerations of it being more natural.
Challenges in the present system are:
❖ Quality standards of Medicines – Scientific validation of AYUSH has not progressed in
spite of dedicated expenditure in past.
❖ Lack of human resources – Practitioners are moving away from traditional system for
better opportunities
❖ The existing infrastructure remains under-utilized.
Research and Development
o More research is required to validate AYUSH therapies
o Cross-disciplinary research with other disciplines will ensure best health practices.
o Standard Treatment Guidelines and a Model Drugs List of AYUSH drugs for community health workers should be developed.
o Quality certification of raw materials is required.
o All education programmes taught in colleges and universities related to AYUSH must be accredited.

Human resources development

o Cross-disciplinary learning between modern and AYUSH systems at the post-graduate level.
o Modification in syllabi at the undergraduate level should be worked by a team of experts from the different Professional
Councils.
o Collaboration between AYUSH teaching colleges and with medical colleges for mutual learning should be encouraged.
o AYUSH graduates should be legally empowered to practice as Primary Health care physicians

Capacity-building of licensed AYUSH practitioners through bridge training to meet India’s primary care needs is only
one of the multi-pronged efforts required to meet the objective of achieving universal health coverage set out in
NHP 2017