Why in news:
- In early November 2021, Finance ministry released {8,453.92 crore to 19 States, as a health grant to rural and urban local bodies (ULBs)
- This allocation has been made as part of the health grant of {70,051 Crore) which is to be released over five years, from FY2021-22 to FY2025-26, as recommended by the Fifteenth Finance Commission
Status of primary healthcare in India-
- Historical context- In 1992, as part of the 73rd and 74th Constitutional Amendments, the local bodies (LBs) in the rural (Panchayati raj institutions) and urban (corporations and councils) areas were transferred the responsibility to deliver primary care and public health services.
Rural primary healthcare-
The healthcare infrastructure in rural areas has been developed as a three-tier system as follows.
1. Sub Centre: Most peripheral contact point between Primary Health Care System & Community.
2. Primary Health Centre (PHC): A Referral Unit for 6 Sub Centers 4-6 bedded manned with a Medical Officer In charge and 14 subordinate paramedical staff
3. Community Health Centre (CHC): A 30 bedded Hospital/Referral Unit for 4 PHCs with Specialized services
Urban primary healthcare-
The health care infrastructure in urban areas consists of the Community Health Centers and Primary Health Centers.
Population norms for urban health infrastructure
• Community Health Centers - 2,50,000 population (5 Lakh for metros)
• Primary Health Centers - 50,000 population
(The U-PHC is located preferably closer to slum or similar habitations.)
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Urban - Health and Wellness Centers-
In order to ensure delivery of Comprehensive Primary Health Care (CPHC) services, existing U-PHCs are being converted to Health and Wellness Centers (HWC). Services could also be provided/ complemented through outreach services, Mobile Medical Units, health camps, home visits and community-based interaction.
Challenges to rural healthcare-
• The underutilization of peripheral centers is attributed to varied factors related to accessibility, quality, affordability, deficient human resource, poor monitoring, lack of community participation and ownership.
• Vast and diverse geographical locations of India inhibit proper penetration of health care delivery in such areas. Further, health care personnel are reluctant to work at block or below level areas, as they have to face two challenges
- First the absence of reasonable living conditions (eg. proper housing, 24-hour electricity supply, good school for their children, social isolation etc.)
- second, the under functioning of majority of health care facilities in such areas and hence no opportunity to translate their technical skills
Unique challenges to urban PHC
• Lack of coordination & clarity on responsibilities related to health services - a multitude of agencies which are responsible for different types of health services (by areas of their jurisdiction).
• Low budgetary allocation- which never crossed ₹1,000 crore (or around 3% of budgetary allocation for the NRHM or ₹25 per urban resident against ₹4,297 per person per year health spending in India).
• Low utilization- In urban settings, most local bodies were spending from less than 1% to around 3% of their annual budget on health
• Gap between the launch of National Urban Health Mission and National Urban Health Mission (NUHM-2013) (NRHM2005)
• Lack of infrastructure- Urban India, with just half of the rural population, has just a sixth of primary health centers in comparison to rural areas.
It is in this backdrop that the Fifteenth Finance Commission health grant — the urban share is nearly five-fold that of the annual budget for the NUHM and rural allocation is one and a half fold that of the total health spending by RLBs in India is an unprecedented opportunity to fulfil the mandate provided under the two Constitutional Amendments, in 1992
Way ahead:
• First, the grant should be used as an opportunity to sensitize key stakeholders in local bodies, including the elected representatives (councilors and Panchayati raj institution representatives) and the administrators.
• Second, awareness of citizens about the responsibilities of local bodies in health-care services should be raised. Such an approach can work as an empowering tool to enable accountability.
• Third, civil society organizations need to play a greater role in raising awareness about the role of LBs in health, and possibly in developing local dashboards (as an mechanism of accountability) to track the progress made in health initiatives.
• Fourth, the Fifteenth Finance Commission health grants should not be treated as a ‘replacement’ for health spending by the local bodies which should alongside increase their own health spending regularly to make a meaningful impact.
• Fifth, mechanisms for better coordination among multiple agencies working in rural and urban areas should be institutionalized.
• Sixth, the young administrators in charge of such RLBs and ULBs to develop innovative health models
UPSC MAINS QUESTION 2019:
Appropriate local community-level healthcare intervention is a prerequisite to achieve 'Health for All ' in India. Explain.
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