Subject: Social Justice

The public healthcare system in India, especially at the grassroots level, remains underfunded, understaffed, and increasingly affected by the growing marketisation of healthcare.

With out-of-pocket expenditure accounting for over 48% of total health spending (NHA, 2022-23), the poor and marginalized are disproportionately impacted. In such a scenario, the State’s proactive intervention is essential to protect public health as a public good rather than a market commodity.

Adverse Impact of Marketisation in Healthcare

• High out-of-pocket expenditure, pushing millions below the poverty line annually.
• Inequitable access, with private providers concentrated in urban areas.
• Profit-driven practices,compromising ethics and transparency.
• Medical overpricing and unnecessary procedures, due to lack of regulation.

State's Role in Healthcare Delivery

• Infrastructure Development:

  • Expansion of Ayushman Arogya Mandirs (163,020 operational as of December 2023) by upgrading existing Sub-Health Centers and Primary Health Centers.
  • Ensuring healthcare facilities within 30-minute reach of every citizen through strategic placement of health centers.
  • Strengthening district hospitals and establishing more medical colleges in underserved regions.

• Human Resource Enhancement:

  • Training and deployment of ASHA workers and ANMs to bridge the last-mile connectivity gap.
  • Implementation of mandatory rural posting for medical graduates.
  • Creating incentive structures for healthcare professionals working in rural areas.

Financial Support and Coverage

• Universal Health Coverage:
  • Strengthening Ayushman Bharat Yojana to improve its utilization rates from current levels (43.3% in Gujarat, 15.2% in Gautam Buddha Nagar).
  • Expanding insurance coverage to include preventive healthcare and outpatient services.
  • Integration of various health schemes under one umbrella for better coordination.

Quality Assurance and Monitoring

• Technology Integration:
  • Implementation of telemedicine facilities in remote areas.
  • Digital health records through Ayushman Bharat Digital Mission.
  • Real-time monitoring of health indicators and service delivery.

Community Engagement

• Participatory Approach:
  • Strengthening Village Health Sanitation and Nutrition Committees.
  • Promoting health awareness through community outreach programs.
  • Engaging local bodies in healthcare planning and implementation.

The State must act not merely as a service provider, but also as a regulator and guardian of the public's health rights. A strong and inclusive public healthcare system not only cushions the population against the commodification of care but also strengthens human capital, productivity, and long-term national development. An equity-driven, decentralised and adequately funded approach is the way forward.