INDIA'S HEALTHCARE SYSTEM

India's  healthcare system  

1. Primary Level in villages­ No MBBS doctors; Multi­purpose health workers (MPWs like ASHA, ANM, Anganwadi) who administer primary health care along with other efforts like vaccination etc. These MPWs are not properly trained. 

2. Secondary level ­­ In blocks.. 2/3 MBBS doctors who do uncomplicated treatment. 

3. Tertiary level ­­ District hospitals 

4. Quaternary level­­ Medical colleges 

5. At present, there is just one doctor for around 1,700 people in India, whereas the WHO stipulates a minimum ratio of 1:1,000  



India's attitude toward Rural Healthcare:  

1. Rural hospitals are working since 1950s (too many rural and urban hospitals were opened in initial years of 50s), various yojnas like NRHM, providing free medicine, vaccination etc.  (So intentions are good ) . 

Criticism:: Good intentions don't suffice. Implementation at ground level is more imp.  

1. Poorly trained health workers­­ therefore only diarrheal deaths etc. 
2. Less availability of medicines also their quality is the problem ( we usually avoid govt. hospital free drugs.)
3. Rural hospitals are very far away from district hospitals. Secondary hospitals are lacking facilities so are of no use. 
4. Quacks or Jholachhap doctors are openly flourishing without any control  of govt. in rural areas.  

Conclusion/ Suggestions :  

1. Implement 3 year Health diploma system where these health workers can be efficiently trained. 
2. ASHA workers should not be contractual. Contractual system demotivates people. 
3. A good inventory of quality medicine should be maintained. 
4. Regulatory mechanisms to check Chansi dawakhanas; Health insurance schemes, free treatment, increase budgetary allocation and fix accountability of doctors and health workers. 

National Rural Health Mission (NRHM)

The National Rural Health Mission (NRHM) was launched on 12th April 2005, to provide accessible, affordable and quality health care to the rural population, especially the vulnerable groups.

NRHM seeks to provide equitable, affordable and quality health care to the rural population, especially the vulnerable groups. Under the NRHM, the Empowered Action Group (EAG) States as well as North Eastern States, Jammu and Kashmir and Himachal Pradesh have been given special focus. The thrust of the mission is on establishing a fully functional, community owned, decentralized health delivery system with inter-sectoral convergence at all levels, to ensure simultaneous action on a wide range of determinants of health such as water, sanitation, education, nutrition, social and gender equality.

NRHM focuses on Reproductive, Maternal, Newborn, Child Health and Adolescent (RMNCH+A) Services. The emphasis here is on strategies for improving maternal and child health through a continuum of care and the life cycle approach. It recognises the inextricable linkages between adolescent health, family planning, maternal health and child survival. Moreover, the linking of community and facility-based care and strengthening referrals between various levels of health care system to create a continuous care pathway is also to be focussed.

Institutional Setup

At the National level, the NHM has a Mission Steering Group (MSG) headed by the Union Minister for Health & Family Welfare and an Empowered Programme Committee (EPC) headed by the Union Secretary for Health & FW. The EPC will implement the Mission under the overall guidance of the MSG.

At the State level, the Mission would function under the overall guidance of the State Health Mission headed by the Chief Minister of the State. The functions under the Mission would be carried out through the State Health & Family Welfare Society.

Strategies

Core Strategies

• Train and enhance capacity of Panchayat Raj Institutions (PRIs) to own, control and manage public health services.
• Promote access to improved healthcare at household level through the female health activist (ASHA).
• Health Plan for each village through Village Health Committee of the Panchayat.
• Strengthening sub - centre through an untied fund to enable local planning and action and more Multi-Purpose Workers (MPWs).
• Strengthening existing PHCs and CHCs, and provision of 30- 50 bedded
• CHC per lakh population for improved curative care to a normative standard (Indian Public Health Standards defining personnel, equipment and management standards).
• Preparation and Implementation of an inter - sectoral District Health Plan prepared by the District Health Mission, including drinking water, sanitation & hygiene and nutrition.
• Integrating vertical Health and Family Welfare programmes at National, State, Block, and District levels.
• Technical Support to National, State and District Health Missions, for Public Health Management.
• Strengthening capacities for data collection, assessment and review for evidence based planning, monitoring and supervision.
• Formulation of transparent policies for deployment and career development of Human Resources for health.
• Developing capacities for preventive health care at all levels for promoting healthy life styles, reduction in consumption of tobacco and alcohol etc.
• Promoting non-profit sector particularly in under-served areas.

Supplementary Strategies

• Regulation of Private Sector including the informal rural practitioners to ensure availability of quality service to citizens at reasonable cost.
• Promotion of Public Private Partnerships for achieving public health goals.
• Mainstreaming AYUSH – revitalizing local health traditions.
• Reorienting medical education to support rural health issues including regulation of Medical care and Medical Ethics.
• Effective and viable risk pooling and social health insurance to provide health security to the poor by ensuring accessible, affordable, accountable and good quality hospital care.

Institutional Mechanisms

• Village Health & Sanitation Samiti (at village level consisting of Panchayat Representative/s, ANM/MPW, Anganwadi worker, teacher, ASHA, community health volunteers
• Rogi Kalyan Samiti (or equivalent) for community management of public hospitals
• District Health Mission, under the leadership of Zila Parishad with District Health Head as Convener and all relevant departments, NGOs, private professionals etc represented on it
• State Health Mission, Chaired by Chief Minister and co - chaired by Health Minister and with the State Health Secretary as Convener- representation of related departments, NGOs, private professionals etc
• Integration of Departments of Health and Family Welfare, at National and State level
• National Mission Steering Group chaired by Union Minister for Health & Family Welfare with Deputy Chairman Planning Commission, Ministers of Panchayat Raj, Rural Development and Human Resource Development and public health professionals as members, to provide policy support and guidance to the Mission
• Empowered Programme Committee chaired by Secretary HFW, to be the Executive Body of the Mission
• Standing Mentoring Group shall guide and oversee the implementation of ASHA initiative
• Task Groups for Selected Tasks (time- bound)