The First Health Policy of 1983 and the Vision There of

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1983 Health Policy Overview:
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 Developed in response to structural adjustment plans and the desire to align with Western standards.
 Shifted from a disease-specific critical and curative approach to a holistic promotive, preventive, and
curative approach.
 Emphasized strengthening primary healthcare centers with an integrative approach.
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Community Participation and Disease Focus:
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 Increased community participation in health services for preventive care and disease screening.
 Targeted communicable and noncommunicable diseases (NCDs) through the policy initiatives.
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Resource Crunch Challenge:
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 Despite policy changes, the overall healthcare architecture remained unchanged.
 Resource constraints hindered the enhancement of healthcare services as outlined in the 1983 policy.
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1990s Liberalization Impact:
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 Liberalization in the 1990s led to increased private sector investments in healthcare.
 Resulted in a widening gap between the rich and poor in accessing healthcare services.
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Health Inequity and Marginalization:
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 The liberalization era had detrimental effects on the health of the poor and marginalized populations.
 The Indian nation-state struggled to protect its citizens during health emergencies, leading to increased
health vulnerability.
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Universal Health Coverage Challenge:
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 The question of achieving universal health coverage remained unanswered by past governments.
 Challenges persisted, and the goal of ensuring comprehensive healthcare for all was elusive.
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Commodification of Healthcare:
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 The commodification of healthcare became a lucrative business for capitalists.
 This further exacerbated disparities in access to healthcare services.
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Unresolved Questions:
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 The overarching issue of universal health coverage continued to be a persistent challenge.
 Governments struggled to provide satisfactory answers to address the healthcare needs of the entire
population.

Pressing Provision of Healthcare and Policies for the Improvement

of Health
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Global Focus on UHC:

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 Universal Health Coverage (UHC) is a worldwide initiative aiming to provide essential healthcare services, particularly
targeting marginalized populations.

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Transformation of Essential Health Packages (EHPs):

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 Essential Health Packages (EHPs) have evolved to ensure the delivery of minimum services to both citizens and refugees.

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World Health Assembly's Resolution (2005):

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 The 58th World Health Assembly in 2005 played a crucial role in transforming EHPs to align with the goal of Universal
Health Coverage.

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Bhore Committee's Role (1946):

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 India's Bhore Committee, established in 1946, has been instrumental in ongoing efforts to improve health services with a
focus on equity, quality, and universal provision.

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Alma Atta Declaration (1978):

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 The Alma Atta declaration underscored the importance of people's involvement in implementing health programs, but
faced resistance in developing countries due to a proposed 5% GNP contribution for health.

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Challenges in GNP Contribution (1978-1979):

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 India allocated only 2.40% of the GNP for health in 1978-1979, falling short of the recommended 5% target.

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Rural-Urban Healthcare Divide (1980s):

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 The 1980s revealed a significant rural-urban healthcare divide in India, posing a challenge to achieving Health Facility
(HFA) goals by 2000.

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Focus on Rural Healthcare Resources:

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 Emphasis was placed on mobilizing resources for rural areas, with a focus on providing both preventive and curative
healthcare services.

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Post-Independence Social Sector Gains:

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 Gains in the social sector post-independence were not uniformly sustained across India, indicating disparities in healthcare
access.

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Population Explosion and Health Financing Challenge:

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 India faces a major concern with population explosion, with public health programs primarily focusing on reproductive and
child health services.
 Low prioritization of health in India's politically charged governance system has contributed to challenges in health
financing.
 Evidence for UHC in India

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Ayushman Bharat Yojna and UHC Focus:
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 India's health sector aims to achieve Universal Health Coverage
(UHC) through reform mechanisms, with the Ayushman Bharat
Yojna being the world's largest inpatient care program.
 The scheme prioritizes preventive and primary care services,
including the establishment of health and wellness centers.
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Resource Challenges and Evidence-Based Policymaking:
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 The Ministry of Health (MOH) faces difficulties in generating
sufficient resources for UHC and often relies on other
government divisions.
 Effective implementation requires health ministries to adopt
evidence-based policymaking and secure budgetary provisions
to meet fiscal requirements.
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World Health Assembly Recommendations for UHC:
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 To achieve UHC, India needs to adhere to recommendations
from the World Health Assembly and the World Health
Organization (WHO).
 Focus areas include ensuring the workability of core
components such as population coverage, service range, and
financial risk coverage to make UHC a reality.
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Bhore Committee (1946) to Astana Declaration (2017):

Response of India Towards Health Care

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 Historical Context of UHC in India:
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 India's pursuit of Universal Health Coverage (UHC) dates back
to its independence, with the Bhore Committee laying the
groundwork for health improvement aspirations at the national
level.
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Alma Atta and Astana Declarations:
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 In 1978, India, as a signatory of the Alma Atta Declaration,
committed to providing healthcare for all. The 2018 Astana
Declaration reaffirmed the importance of primary healthcare,
stressing quality, safety, comprehensiveness, and accessibility. It
emphasized immediate action against various health challenges
such as chronic diseases, substance abuse, poor lifestyles, and
unhealthy diets.
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Integration of Astana Declaration in Indian Health Policies:
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 The Astana Declaration should guide India's health sector
policies, emphasizing the integration of primary care into the
healthcare system to cater to its large population. The focus on
fair provision of healthcare services aligns with the evolving
philosophy of ensuring health equity in India.
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Exclusive Government Resources in the Progress of

Healthcare in India

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Bhore Committee's Primary Healthcare Recommendations (1950s):
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 The Bhore Committee report in the 1950s advocated for significant investment in India's primary healthcare
system, emphasizing the importance of public finance for health improvement.
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Bureaucratic Challenges in Implementation:
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 Despite recommendations, the objective of public finance for health issues has largely remained confined
to bureaucratic documents, with limited translation into practical initiatives.
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State Government Responsibilities:
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 State governments bear responsibilities within their geographical jurisdiction, but many struggle to grasp
and fulfill their role in improving healthcare.
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Central Government Guidelines and Fiscal Provisions:
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 Central government guidelines and expert knowledge often remain unutilized due to a lack of fiscal
provisions in government budgets, hindering effective implementation.
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Structural Adjustment Plan Impact (1980s):
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 In the 1980s, the structural adjustment plan compelled healthcare financing to increase investment in the
health sector, indicating the influence of economic reforms on public health.
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Healthcare as Public Goods in Economic Theories:
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 The provision of healthcare services as public goods is deeply rooted in economic theories of development,
emphasizing its importance for societal well-being.
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Uncertainty and Information Asymmetry:
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 Uncertainty in healthcare services and information asymmetry in the health sector contribute to market
failure, highlighting the challenges in delivering equitable healthcare.
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Government's Role in Providing Public Goods:
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 The government is urged to consider healthcare as a public good, ensuring its provision to the people and
striving for the equitable distribution of healthcare services.
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Two Types of Progress in Healthcare:
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 India experiences two types of progress in healthcare, with public expenditure on health consistently
hovering around 0.9% of GDP for decades, indicating limited growth in financial allocations.
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Biases and Inequalities in Public Health System:
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 Biases and inequalities persist in providing financial resources within the public health system, leading to a
situation where the government struggles to provide the population with decent healthcare services.