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Table of Contents
Pyqs................................................................................................................... 3
INTRODUCTION -.............................................................................................. 4
Healthcare in the Constitution of India.............................................................. 7
Issues with the Public Healthcare System.......................................................... 8
Measures to Address Issues Facing the Public Healthcare System....................10
AYUSH............................................................................................................. 12
Reform in Regulation of Medical Education and National Medical Commission..
17
National Health Policy-2017............................................................................. 19
Mental Health.................................................................................................. 23
Ayushman Bharat-PMJAY................................................................................28
National Digital Health Mission (NDHM).........................................................33
ASHA (Accredited Social Health Activist) Workers.......................................... 38
Preventative And Primary healthcare healthcare............................................. 41
Universal Health Coverage (UHC).................................................................... 45
Non-Communicable Diseases (NCDs).............................................................. 48
Tribal Health.................................................................................................... 51
Antimicrobial resistance.................................................................................. 55

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Health
Pyqs
[2021]-. “Besides being a moral imperative of a Welfare State, primary health structure is a
necessary precondition for sustainable development.” Analyse.(10M)
[2020]-In order to enhance the prospects of social development, sound and adequate health
care policies are needed particularly in the fields of geriatric and maternal health care.
Discuss (10M)
[2018]-Appropriate local community-level healthcare intervention is a prerequisite to
achieve 'Health for All ' in India. Explain.(10M)
[2017]-‘To ensure effective implementation of policies addressing water, sanitation and
hygiene needs, the identification of beneficiary segments is to be synchronized with the
anticipated outcomes’ Examine the statement in the context of the WASH scheme.(10M)
[2016]-Professor Amartya Sen has advocated important reforms in the realms of primary
education and primary health care. What are your suggestions to improve their status and
performance? (12.5M)
[2015]-Public health system has limitations in providing universal health coverage. Do you

would you suggest?(12.5M)

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think that the private sector could help in bridging the gap? What other viable alternatives

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[2013]-Identify the Millennium Development Goals (MDGs) that are related to health.
Discuss the success of the actions taken by the Government for achieving the same.(10M)

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INTRODUCTION -
Health is a state of complete physical, mental and social well-being and not merely the
absence of disease or infirmity. Therefore, emotional and social capital is equally important
for realising vision of SDG 3 i.e. Good Health and well-being-WHO

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National Health Account Estimates Expenditure on Health Care :

(2019-20) : ● 2.1% of GDP in FY23 [Eco. Survey
Total Health Expenditure as a percent 2022-23]
of GDP and Per Capita ● World Average: 6%
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 ● Total Health Expenditure as ● National Health Policy, 2017:
declined from 4% to 3.3% in Increase public health expenditure
2019-20 (In Comparison to 2013-14) to 2.5% of the GDP.
● Total Health Expenditure per capita ● Government spending on health per
increased to ₹4,863 from ₹3,638 in person was Rs 1,815 while out of
2019-20 (In comparison to 2013-14) pocket expenditure per capita was
● Government Health Expenditure Rs 2,155.
(GHE) as a percent of Total Health ● 51% spent on curative health care
Expenditure Increased from 28.6% ● 6% spent on preventive healthcare
to 41.41% in 2019-20 (In
comparison to 2013-14) Out-of-pocket Health Expenditure :
● Out-of-Pocket Expenditure (OOPE) ● Share of Out-of-Pocket Expenditure
as a percent of Total Health (OOPE) in Total Health Expenditure
Expenditure declined from 64.2% to declined from 62.6% in 2014-15 to
47.1% in 2019-20 (In Comparison to 47.1% in 2019-20 (National Health
2013-14) Accounts (NHA) Estimates).
● Per capita out-of-pocket health
expenditure declined from ₹2,336 to
₹2,097. (National Health Accounts
estimates 2017-18; released in 2021)
● OOPHE pushes over 55 million
people in India into poverty.

Deaths : Medical Equipment : 70-80%Imported

● Non-communicable diseases led to
66% of deaths[WHO]. Y x
Active Pharmaceuticals Ingredients :
● Over 60.46 lakh people died due to
NCDs in 2019 E R
India imports 70%-80% of its API
requirements from China.

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● 22% probability of death between
the age of 30 and70 due to any type
Target: 25% cut in API import reliance by
2024
of non-communicable disease,
including cardiovascular diseases, Patient-Bed Ratio Per 1000 (India) :
cancer or diabetes. ● 0.5 public hospital beds per 1,000
Maternal Mortality Rate : population and mere 1.4 beds,
● Declined: 97 deaths per lakh in including public and private hospital
2018-2020 from103 deaths per lakh beds per 1,000 persons.
in 2017-2019 ● Delhi has 2.71 hospital beds per
● India is all set to achieve Sustainable 1,000.
Development Goals (SDGs) target of ● District hospitals have avg 24 beds
MMR of 70 maternal deaths per per 1 lakh people (NITI AAYOG
lakh live births by 2030. report)
● According to WHO standards, a
minimum of3 beds per 1000 is
required.

Urban-rural divide : Rural Areas have Status of Immunisation among

only 70% population and around 20% children aged 0-5 years:
Hospitals. ● About 97% of children across the
country received at least one
Birth attended by Skilled vaccination — mostly BCG and/or
Professionals the first dose of Oral Polio Vaccine
● 81% (2015-16) (World Bank at birth, but two out of five children
Development Indicators) (40%) do not complete their
immunisation programme.

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 ● NFHS 5: Institutional delivery is ● Among States, Manipur (75%),
over 90% in 14 out of the total 22 Andhra Pradesh (73.6%) and
States and UTs Mizoram (73.4%) recorded the
highest rates of full immunisation.
Insurance Penetration : Risen steadily ● In Nagaland, only 12% of children
from 2.7% in 2000 to 4.2% in 2020 and was received all vaccinations, followed
3.2% in 2021 [Eco. Survey 2022-23] by Puducherry (34%) and Tripura
(39.6%).

Maternal Health: Non-communicable diseases

● Institutional deliveries: In rural (NCD)
areas, about 90% childbirths were (WHO report)
institutional (in ● Global: NCD responsible for 70%
Government/private hospitals) and of all deaths worldwide
in urban areas it was about 96%. ● India: > 60% of all deaths in India
● Pre and Postnatal Care: Among can be attributed to NCDs.
women in the age-group 15-49 ● 1 in 4 Indians risks dying from an
years, about 97% of women took NCD before they reach the age of 70.
prenatal care and about 88% of ● Cancer, diabetes and heart
women took postnatal care. diseases alone account for 55% of
● Maternal Mortality Rate the premature mortality in India in
(proportion of maternal deaths per the age group of 30‐69 years.
1,00,000 live births reported) of ● Main risk factors: Physical
India has declined from 130 in
2014-2016 to 122 in 2015-17. Y xinactivity, tobacco use, excessive use
of alcohol, unhealthy diets and

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● National Programme for Prevention

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Diseases (NP-NCD)
● WHO’s Global action plan for the
Prevention and Control of NCDs
2020 to 2030; Affordable Medicines
and Reliable Implants for Treatment
(AMRIT)
● Deendayal outlet, Jan Aushadhi
stores, SDGs- reduce premature
mortality from NCDs by one-third
by 2030 (SDG 3.4)

Healthcare in the Constitution of India

1. Our Constitution requires the State to ensure health and nutritional well-being of all
people as its duty under various articles of Directive Principles of State Policy such as
Article 39(e): Securing health of workers, men and women.
Article 41: Public assistance basically for those who are sick and disabled.
Article 42: To protect the health of infants and mothers by maternity benefit.

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 Article 47: Raising of the level of nutrition and standard of living of its people and
improvement of public health
2. The Supreme Court in various judgments (such as CESC Ltd. vs. Subash Chandra
Bose; Paschim Banga Khet mazdoor Samity; Murali S. Deora; N. D. Jayal etc.) has
enlarged the scope of Article 21 to also include Right to Health.

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Issues with the Public Healthcare System
1. Insufficient Expenditure: India spends approximately 1.4% of its GDP on
healthcare, significantly lower than BRICS countries: Brazil (8.3%), China (6.4%),
Russia (7.1%), and South Africa (8.8%).
2. Inadequate Infrastructure:
a. According to India Spend, 63% of Primary Health Centres (PHCs) lack an
operation theatre, and 29% do not have a labour room.
b. India has 8.5 hospital beds per 10,000 citizens.
3. Human Resources:
a. Only one doctor for every 1,456 citizens (WHO norm is 1:1000).
b. 1.7 nurses per 1,000 people (WHO norm is 3:1000).
4. Large-Scale Regional Disparities:
Healthcare Inequality: Public healthcare facilities are unevenly distributed across
developed and backward areas, rural and urban areas (only about 25% of the total
healthcare infrastructure is in rural areas), and among various states e.g. Kerala has
one government hospital bed per 1,300 people, while Bihar has one per 28,000
people.
5. Lack of Synergy:Health being a state subject results in various Union and State
government initiatives working in silos, limiting resource optimisation.
6. High Out-of-Pocket Expenditure (OOPE):
a. Out-of-Pocket Expenditure constitutes 67% of Current Health Expenditure.
b. According to recent NSSO data, private hospitals account for 55% of
in-patient hospitalisation cases, while public hospitals account for 45%.

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 c. Only 14% of the rural population and 19% of the urban population reported
having health expenditure coverage, leading to higher OOPE.
d. According to OECD, India's total out-of-pocket expenditure is around 2.3% of
GDP.
7. Lack of Primary Healthcare Services: The existing public primary healthcare
model is limited, providing only pregnancy care, limited childcare, and services
related to national health programs, representing just 15% of all morbidities for
which people seek care.
8. Supply-Side Deficiencies:
Poor Health Management: Inadequate training and supportive supervision for health
workers hinder the delivery of quality health services.
9. Challenges in Prevention and Detection: Difficulty in addressing prevention
and early detection, diminishing preparedness and effective management for
emerging threats like the COVID-19 pandemic.
10. Low Health Literacy: Limited awareness about chronic diseases, symptoms, and
the inability of patients to understand health information and instructions lead to
delays in timely intervention.
11. Regional Disparities are evident in differences between rural-urban gaps and
inter-state gaps.
a. According to a KPMG report, 74% of India’s doctors cater to a third of urban
population.
b. As a consequence, India is 81% short of specialists at rural community health
centres.
c. The 25,308 primary health centres (PHCs) spread across India’s rural areas

10 years.
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are short of more than 3,000 doctors, with shortage up by 200 % over the last

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d. According to the NHP, 2018, in Bihar, one doctor serves a total population of
28,391 whereas in Delhi, the figure stands at 1:2203.
12. Prevalent Malnutrition:

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a. Global Hunger Index:India ranked 102 out of 117 countries in the 2019 Global
Hunger Index, indicating a serious level of hunger.
b. Child Malnutrition: India has the highest number of stunted (46.6 million)
and wasted (25.5 million) children in the world.
c. Overweight Children: More than a million children are overweight.
d. Anaemia in Women: Around 40% of women (aged 15-49 years) are anaemic.

Major Healthcare Issues Highlighted During COVID-19

Availability of Basic Infrastructure:

1. Hospital Beds: India has 8.5 hospital beds per 10,000 citizens.
2. Doctors and Nurses: There is one doctor for every 1,456 citizens (WHO norm is
1:1000) and 1.7 nurses per 1,000 people (WHO norm is 3:1000).
3. Ventilators:Insufficient number of ventilators in hospitals for patients with
severe COVID-19 infections.
4. Diagnostic Labs: Limited accredited diagnostic labs delay testing and
understanding of disease progression.

Uneven Distribution of Healthcare Workforce:

Urban-Rural Divide: Most healthcare workers practise in metropolitan or tier I and II
cities, leading to personnel shortages in small towns and villages.

Denial of Healthcare:
Private Hospitals: Private hospitals have reportedly denied treatments to the poor and
overcharged patients, despite having 62% of total hospital beds, ICU beds, and 56% of

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ventilators. eg. In Bihar, the private health sector, which has nearly twice the bed capacity
of the public sector, has almost completely withdrawn.

Negative Perception of Medical Career:

PPE Shortages: Stories of PPE shortages leading to health workers getting infected, and
instances of health workers being attacked by patients and relatives, may create a
long-term negative perception of a medical career in India.

Gaps in Urban Health Services and Planning:

Urban Areas: The COVID-19 pandemic disproportionately affected urban areas,
highlighting the lack of public health services, especially in suburban regions.

Dysfunctional Integrated Disease Surveillance Programme (IDSP):

Launch and Objectives: Launched in 2004 to strengthen a decentralised,
laboratory-based, IT-enabled disease surveillance system for epidemic-prone diseases.
Current State: Struggles with manpower and resources, failing to create a robust and
decentralised data collection system involving the district health system across states.

Gaps in Care of Non-COVID-19 Patients:

Neglect of Chronic Diseases: Extreme focus on COVID-19 containment has likely
resulted in missed opportunities for timely diagnosis and treatment of other chronic
diseases.

Other Issues:

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1. Pharmaceutical Imports: India’s dependence on imports for pharmaceutical
products like Active Pharmaceutical Ingredients (APIs).

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2. Alternative Medicine: Disbelief in alternative/traditional medicines due to a
lack of research in AYUSH treatments and absence of precise standards for herbal
formulations.
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3. Preventive Healthcare: Lack of focus on preventive healthcare, with only 7% of
healthcare spending allocated to prevention, while over 80% was spent on
treatment and cure as of FY17.

Measures to Address Issues Facing the

Public Healthcare System
1. Enhance Public Funding: Increase public health funding to at least 2.5% of GDP,
as envisioned in the National Health Policy, 2017.
2. Strengthening Physical Infrastructure:
a. Increase Healthcare Facilities: Construct sufficient primary health
centres in rural areas, such as the creation of Health and Wellness Centres
under Ayushman Bharat.
b. Strengthen District Hospitals: Incentivise states to increase the ratio of
hospital beds to the population and establish general ICUs and
High-Dependency Units for every 1 million population.
c. Public-Private Partnership (PPP): Implement a comprehensive PPP
model for providing healthcare services in public hospitals and opening
medical institutions, as proposed by NITI Aayog.

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3. Upgrading and Expanding Primary Healthcare:
a. Quality Workforce: Focus on enhancing the quality of health workers
through various means, such as instituting a public health and management
cadre. Establish more medical colleges and increase the number of seats in
existing ones.
b. Training and Provisions: Prioritise training and provision of medical and
support staff. Introduce a certification programme for ASHAs for their
preferential selection into ANM, nursing, and paramedical courses.
4. Rural Service:
a. Incentivise Rural Service: Address the urban-rural gap by incentivising
and mandating rural service for medical students at various health centres.
b. Adequate Amenities: Provide incentives and adequate amenities to doctors
working in rural areas.
5. Use of Technology:
Telemedicine: Utilise technology to provide basic healthcare services to rural areas,
such as telemedicine. Align the public health system with the National Health Policy
2017 and NITI Aayog proposals to achieve SDG 3, i.e., Good Health and Well-Being
for All.
6. Enabling Preventive Care:
a. Health and Wellness Centres (HWCs): Promote preventive care by
converting primary healthcare centres into HWCs, which will act as pillars of
preventive care and gateways for access to secondary and tertiary health
services.

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b. Funding through CSR: Accelerate the establishment of a network of HWCs
with extra funding mobilised through Corporate Social Responsibility (CSR).

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7. Promote AYUSH: Also promote AYUSH systems of medicine.
8. Bringing Behavioural Change: Encourage people to eat right, sleep well,

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maintain good hygiene, exercise, and adopt a healthy lifestyle. Launch a Swasth
Bharat Jan Andolan to catalyse public participation for a healthy India.
9. Cooperative Federalism: Given the significant role of states in creating robust
health systems, allocations by the Finance Commission can be critical for
transforming the nation’s health. Incentivise state governments to invest in creating a
dedicated cadre for public health at state, district, and block levels.
10. Decentralisation:
Integrate WASH: Integrate nutrition, water, sanitation, and hygiene (WASH) into
the core functions of Panchayati Raj institutions and municipalities.
11. Creating a Nodal Health Agency: Establish a designated and autonomous focal
agency with the necessary capacities and linkages to perform functions such as
disease surveillance, gathering information on the health impact of policies of key
non-health departments, maintaining national health statistics, enforcing public
health regulations, and disseminating information to the public.
12. National Health Stack: Operationalise NITI Aayog’s National Health Stack as
soon as possible.
13. Addressing the Root Causes of Health Inequities: The healthcare system
should work in coordination with other sectors, such as education, housing and
sanitation to address the social determinants of health and reduce overall health
inequities.
14. Tax Reductions: Incentivising R&D (Research and Development) by additional
tax deductions to further support greater investments in new drug developments
and reducing GST (Goods and Services Tax) on life-saving and essential drugs is
necessary.
15. Towards One Health Approach: There is a need to recognize that the health of
people is closely connected to the health of animals and our shared environment,

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 and collective health initiatives covering healthy atmosphere, healthy animals, and
healthy humans are the need of the hour.

AYUSH
India faces a dual burden of under-nutrition and communicable diseases, along with the
rising prevalence of non-communicable ailments.

AYUSH (Ayurveda, Yoga, Unani, Siddha, and

Homeopathy) can play a crucial role:

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1. Holistic Approach: Unlike modern medicine, AYUSH follows a more holistic
approach, promoting overall well-being rather than focusing solely on curing illness.

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2. Chronic Conditions: This holistic approach is particularly significant for
non-communicable diseases, which are difficult to treat once they become chronic.

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3. Scientific Evidence: Internationally, there is growing scientific evidence
supporting the health benefits of alternative medicine systems, especially Yoga.
4. Rich Heritage: India has a rich heritage in traditional medicine and nearly eight
lakh registered AYUSH practitioners whose services can be better utilised for
healthcare delivery.
5. Health Benefits:
a. Immunity Booster: Ayurvedic treatments boost immunity.
b. Mental Well-being: Yogic breathing exercises improve mental health.
c. Healthy Lifestyle: Unani system promotes health through a suitable diet
and lifestyle.
d. Non-Toxic: Homoeopathic medicines are safe and enhance dynamic
properties.
e. Holistic Approach: Takes into account body, mind, soul, and senses.
f. No Side Effects: Generally safe with a long history of use.
6. Better Health Services:
a. Availability: Common in rural areas.
b. Reliance: 70% of India’s population depends on traditional medicine.
c. Affordability: Low-cost services compared to allopathic medicines.
d. Complementary Role: Important in treating chronic illnesses and
improving life quality.
e. Universal Healthcare: The doctor-patient ratio is expected to improve with
AYUSH practitioners.
f. Research and Development: Provides guidance in selecting and obtaining
plant material of therapeutic interest.

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Challenges Faced by AYUSH
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1. Scepticism from Health Professionals: Health professionals often question the

efficacy of Ayurveda, Unani, and Homoeopathic medicine in dealing with serious
illnesses.
2. Non-integration into Mainstream Medicine: Efforts to mainstream AYUSH
medicine have primarily focused on increasing the number of AYUSH facilities
without adequately addressing their effectiveness in the healthcare system.
3. Status Gap:
a. The subservient status of AYUSH presents a major hurdle, compounded by
dishonest practices and claims by some practitioners, which lead to ridicule
and scepticism.
b. The commercialization and export promotion of AYUSH products have led to
a negative perception of the field.

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 4. Isolationist Approach: This approach conflicts with the modern medical ideal of
embracing evidence-based concepts, hindering scientific scrutiny and potential value
addition in traditional medicine.
5. Quality Standards of Medicines: Scientific validation of AYUSH has not
progressed despite dedicated expenditure, leading to concerns about the quality of
AYUSH medicines.
6. Lack of Human Resources: Many practitioners are moving away from traditional
systems for better opportunities, leading to an under-utilisation of existing
infrastructure.
7. Under-utilised Infrastructure: The 2013 Shailaja Chandra report highlighted
instances where AYUSH physicians recruited under the National Rural Health
Mission were the sole care providers in PHCs, calling for appropriate skilling to meet
the demand for acute and emergency care at the primary level.
8. Competition with Modern Medicine:
a. Dishonest practices by some AYUSH practitioners make allopathic medicine
appear more trustworthy.
b. Scepticism towards AYUSH treatments is prevalent, especially among
allopathic practitioners.
c. The cosmeticisation of AYUSH products as natural or organic, compared to
artificial allopathic products, has led to a distorted focus on export promotion.
9. Lack of Dedicated Efforts: There is a significant status gap between modern
medicine and AYUSH, and little has been done to harmonise the two sectors. Simply
expanding AYUSH’s framework will only exacerbate existing problems.
10. Conflict of Interests: The AYUSH lobby fears a loss of identity following

dilute medical care standards.

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integration, while the allopathic lobby alleges that integrating the systems would

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Government Steps to Promote AYUSH:G

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1. Dedicated Ministry: A dedicated ministry for AYUSH was established at the

Central level in 2014.
2. National Health Policy, 2017: Mainstreaming AYUSH is a clearly stated policy
objective.
3. Centre for Integrative Medicine & Research: Established by AIIMS, Delhi.
4. AYUSH Units in Hospitals: Several union ministries plan to set up AYUSH units
in their hospitals.
5. Champion Services Sector: AYUSH is one of the 12 champion services sectors
promoted by the government through soft loans, interest subsidies, and 100% FDI.
6. Schemes:
a. Ayush Grid: A project for the digitization of the AYUSH sector.
b. National AYUSH Mission: Mainstreaming AYUSH under the National
Health Mission and National Health Policy-2017.
c. Ayushman Bharat: Upgrading 10% of sub-centres to Health and Wellness
Centres (HWCs).

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 d. Traditional Knowledge Digital Library (TKDL): A repository of
traditional knowledge containing information on medicinal plants and
formulations.
e. Protection from Patent Registration: Preventing the patenting of
traditional medicinal knowledge through TKDL.
7. Conferences:
a. International Conference on Standardisation of Diagnosis and
Terminologies in Ayurveda, Unani and Siddha Systems of
Medicine (ICoSDiTAUS) 2020: organised by the Ministry of AYUSH and
WHO.
b. New Delhi Declaration on Collection and Classification of
Traditional Medicine Data: Emphasised the commitment to traditional
medicine as a significant area of healthcare.

Way Forward:
1. Co-Location:
a. Integration with Allopathic Medicine: There is a need to co-locate
AYUSH with facilities providing allopathic medicine.
b. Targets by NITI Aayog: The 'Strategy for New India @ 75' aims to co-locate
AYUSH services in at least 50% of primary health centres, 70% of community

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health centres, and 100% of district hospitals by 2022-23.
c. Health and Wellness Centres: Co-location should also be achieved in the

2. Education & Research:

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1.5 lakh health and wellness centres announced in the Union Budget 2018-19.

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a. Increased Investment: Investments in AYUSH education and research
need to be stepped up.
b. Integration with Modern Medicine: Mechanisms should be identified for
integrating modern medicine and AYUSH curricula at undergraduate and
postgraduate levels.
c. Research Base: Developing a credible research base is critical to embed
AYUSH within the overall healthcare framework and address concerns about
its effectiveness.
3. Awareness:
a. Communication Channels: Various communication channels should be
used to popularise Ayurveda and Yoga and inform citizens about their
preventive and curative properties.
b. Yoga Benefits: While Yoga has gained popularity as a form of exercise, the
full range of its physical and mental health benefits should be propagated.
4. Medicines:
a. Inclusion in Health Programmes: Essential AYUSH medicines must be
included in various national health programmes.
b. Quality Guidelines: Guidelines should be developed to ensure the quality
of AYUSH medicines.

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Reform in Regulation of Medical Education
and National Medical Commission

Need for Regulation and Restructuring:

Acknowledged by SC and Parliamentary Standing Committee: Both entities
suggested reforms in the Medical Commission of India (MCI).

Objectives:
1. Ensure doctors are appropriately trained and skilled to address the prevailing disease
burden.
2. Maintain a uniform standard of competence and skills among medical graduates.
3. Ensure that only individuals with basic knowledge of science and aptitude for the
profession are admitted.The Mudaliar Committee (1959) highlighted that doctors
lacked the skills and knowledge to handle primary care and infectious diseases, a
concern still relevant today.
4. Address the issue that around 57% of allopathic doctors practising medicine do not
have medical qualifications.
5. Promote ethical practice in the interest of patients.
6. Create an environment that fosters innovation and research.

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Issues with the MCI: E R
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1. Independent Functioning: Marred by corruption scandals, capitation fees, and
lack of alignment between the demand for specialities and the supply.
2. Licence Raj: MCI required a college to be inspected nearly 25 times to get final
recognition, each visit being a rent-seeking exercise.
3. Commercialisation of Medical Education: The 1990s saw the
commercialisation of medical education, further aggravated by the 1993 amendment
of the MCI Act, which reduced MCI's autonomy.
4. Rural-Urban Divide: With 69% of the population in rural areas, only 21% of
doctors serve them.

National Medical Commission Act: Important Features:

1. Composition: NMC will consist of 25 members, appointed by the central
government. A SearchCommittee will recommend names to the central government
for the post of Chairperson, and the part time members.
2. Members of NMC: Chairperson (must be a medical practitioner), Presidents of the
UnderGraduate and Postgraduate Medical Education Boards, Director General of
Health Services,Directorate General of Health Services, Director General, Indian
Council of Medical Research,and five members (part-time) to be elected by the
registered medical practitioners from amongst themselves from states and union
territories for a period of two years.
3. Medical Commission Setup: Establishes a medical commission at both national
(NMC, a 25-member body) and state levels within three years of the legislation's
passage.
4. Medical Advisory Council: The Centre will set up this council to convey the views
and concerns of the states/Union Territories to the NMC.
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 5. Uniform NEET: A National Eligibility-cum-Entrance Test (NEET) for admission to
undergraduate medical education in all institutions regulated under the Bill.
6. National Exit Test (NEXT): For medical graduates to obtain a licence to practise
and for admission into postgraduate courses.
7. Licensing of Community Health Providers: NMC to licence 3.5 lakh
non-medical persons to practise modern medicine.

Potential Benefits of the NMC Act:

1. Professionalisation: NMC can be a game changer by professionalising medical
education with experts at all levels.
2. Curricula and Flexibility: Rational and flexible in setting curricula, adding new
courses, and providing multispectral perspectives.
3. Alignment with Disease Burden: Potential to link disease burden with the
production of specialists, similar to the UK's approach.
4. Innovation and Research: Given the right people, NMC can incentivise
innovation and promote research by making it a prerequisite in medical colleges.
5. Accountability and Transparency:
a. Transparency: Members must declare their assets and submit a
conflict-of-interest declaration.
b. Cool-off Period: A two-year cooling-off period after tenure.
6. Access to Health Care Services:
a. Human Resource: Allows community health providers to practise medicine.

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b. Quality and Affordable Healthcare: Aims to provide quality medical education

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c. Universal Healthcare: Promotes equitable access to healthcare services.
7. Uniformity: NEET and NEXT exams to ensure standard competence.

medical practitioners.
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8. Grievance Redressal Body: State Medical Councils to handle complaints against

Concerns and Criticisms:

1. Section 32: Licensing of 3.5 lakh non-medical persons to practise modern medicine
might weaken modern medicine in India.
2. Community Health Provider Definition: Vaguely defined, potentially legalising
quackery.
3. National Exit Test (NEXT): Criticised by IMA, arguing that merit alone should
determine PG seat allocation.
4. Regulation of Fees: NMC would regulate fees for 50% of seats in private medical
colleges and deemed universities, which may not cap fees charged by unaided
institutions, potentially promoting capitation fees.
5. Government Control: Of the 25 members proposed for the NMC, only five would
be elected, with the rest being government officials or nominees, leading to concerns
about government control.
6. Undemocratic: Only 20% of NMC members are elected representatives.
7. Governance Related:
a. Security of Tenure: Central government can remove NMC members.
b. Absence of Independent Appellate Body: Central government is the
appellate authority.
c. Absence of Diverse Stakeholders: The regulator should include more
diverse stakeholders.
8. Against Federal Features: NMC’s decisions not binding on state medical councils.
9. Fee Regulation: NMC to frame guidelines for fee caps in private colleges.
10. Community Health Provider: Vaguely defined role.
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 11. National Exit Examination: Variation in education standards across states.
12. Lack of Judicial Expertise: Disputes related to ethics and misconduct require
judicial expertise.

National Health Policy-2017

Aims to strengthen India's health system, covering various dimensions such as disease
prevention, health promotion, health investment, human resources, technological
advancements, and more.
The National Health Policy, 2017, which replaced the previous policy adopted in 2002,
outlines comprehensive strategies to enhance the healthcare system in India.

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Objectives:
1. Basic Structure:
a. Commitment to Integrity: Upholds the highest professional standards and
ethics in healthcare delivery services.
b. Transparency and Sustainability: Integrates these values into the
healthcare system to ensure long-term efficacy and trust.
2. Eliminating Disparities:
a. Inclusive Health Services: Ensures superior health services for every age
group and gender.
b. Equity in Healthcare: Strives to eliminate disparities in healthcare access
across different regions and social groups.
3. Universal Healthcare Services:
a. Accessibility: Provides universal access to high-quality healthcare services
at an affordable price.
b. Regional Balance: Prevents regional disparities in health care availability
and quality.
4. Reducing Mortality Rate:
a. Targeted Reduction: Aims to reduce premature mortality from cancer,
cardiovascular diseases, chronic respiratory diseases, and diabetes by 25% by
2025.
b. Sustainable Development: Emphasises sustainable development and sets
time-bound quantitative goals to track progress.
5. Developing Overall Health Structure:

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a. Comprehensive Care: Improves the overall health structure through
promotive, palliative, and rehabilitative services.

systematic reforms.
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b. Quality of Care: Focuses on enhancing the quality of care through

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Aims:
1. Professionalism, Integrity, and Ethics: Centers on maintaining high standards
of professionalism, integrity, and ethics in healthcare practices.
2. Universal Access: Aims to achieve universal access to good quality healthcare
services without causing financial hardship.
3. Increased Public Health Expenditure: Intends to gradually increase public
health expenditure to 2.5% of GDP.
4. Free Essential Services and Healthcare Accessibility: Proposes free drugs,
diagnostics, and emergency and essential healthcare services in public hospitals.
5. Focus on Primary Care: Advocates for allocating two-thirds of resources to
primary care to strengthen the foundational level of healthcare.
6. Emergency Care: Proposes having two beds per 1,000 population to ensure access
within the first 60 minutes after a traumatic injury.
7. Non-Communicable Diseases (NCDs) Prevention and Control: Aims to
reduce morbidity and preventable mortality of NCDs by advocating pre-screening
and early detection.
8. Integration of AYUSH: Highlights AYUSH as a cost-effective tool for prevention
and therapy also Proposes introducing Yoga in more schools and offices to promote
good health.
9. Medical Education Reform: Aims to reform medical education to produce
well-trained healthcare professionals.
10. Quantitative Targets for life expectancy, mortality, and disease prevalence
reduction.
11. Changing Health Priorities: Tackles the increasing burden of non-communicable
and infectious diseases in India.
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 12. Growth of the Healthcare Industry: Strengthens the healthcare industry
through technological advancements.
13. Lowering Expenditure: Aims to reduce medical expenses and provide superior
services to poor and backward communities.
14. Economic Growth: Enhances fiscal capacity by boosting economic growth.

Drawbacks of the Policy:

1. Repetition of Ideas: The new policy repeats several old ideas and fails to fulfil the
2015 promise of a Right to Health. Fails to make health a justiciable right, unlike the
Right to Education Act of 2005.
2. Assurance-based Approach: Abandons the radical change proposed in the 2015
draft policy where the National Health Rights Act aimed to make health a right.
3. Disagreement with States: The idea was dropped because state governments felt
that health infrastructure was not yet sufficient to make health an entitlement, and
citizens could theoretically take the government to court for its denial.
Diagnostics, drugs, and essential healthcare services are already free in many states.
4. Longevity in Implementation: The policy aims to meet the 2.5% GDP spending
target for health by 2025, but the HLEG report of 2011 had set the same target for the
Plan ending in March 2017.
5. Health Cess: The health cess, proposed in the Health Ministry’s draft policy, was
rejected, with officials maintaining there is no dearth of funds.

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Way Forward:
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1. Increase Public Investment in Healthcare: The government should increase

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budgetary spending on healthcare and allocate more resources to build a strong
healthcare infrastructure.
2. Enhance Health Expenditure: Health expenditure, currently lower than in most
developing nations, needs to be increased as a percentage of GDP.
3. Prioritise Primary Sector: Strengthening the primary healthcare sector should be
a priority.
4. Expand Health Insurance Coverage: Expanding health insurance coverage to all
citizens would help reduce out-of-pocket expenses and make healthcare more
affordable.
5. Improve Healthcare Quality: The government should invest in developing
quality standards, ensuring adherence, and providing training to healthcare
providers.
6. Invest in Health Information Systems: Develop robust health information
systems that provide timely and accurate data.
7. Promote Preventive Healthcare: Focusing on preventive healthcare can reduce
the disease burden and the cost of healthcare.

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Mental Health
According to WHO (World Health Organization), mental health is defined as “a state of
well-being in which the individual realises his or her abilities, can cope with the normal
stresses of life, can work productively and fruitfully, and is able to contribute to his or her
community”.

According to Sigmund Freud, mental health is the capacity of an individual “to work and to
love”.

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Issues and Challenges:
1. Mental Hospitals: Only 0.01 mental hospitals per 100,000 population, consistent
with other developing countries (WHO data).
2. Outpatient Facilities: India ranks 99th, with 0.18 units per 100,000 population.
3. Day Treatment Facilities: India ranks 64th in the distribution of mental health
day treatment facilities.
4. Community Residential Facilities: India ranks 58th, with 0.017 units per
100,000 population (2016 WHO data).
5. Types of Mental Illnesses: Include anxiety disorders, psychotic disorders, mood
disorders, substance use disorders, personality disorders, and eating disorders.
6. Suicide Rates: The global suicide rate was 10.6 per 100,000 population, while in
India, it was 16.3 per 100,000 in 2016. The rate was higher among males compared
to females.
7. Mental Health Facilities: Challenges include funding, delivery of mental health
packages, and a lack of trained staff.
8. According to the National Mental Health Survey conducted by NIMHANS in 12
States, the prevalence of mental morbidity is high in urban metropolitan areas.
Nearly 1 in 20 persons suffer from depression. 0.9 % of the surveyed population were
at high risk of suicide.
9. WHO Data: Patients with severe mental disorders experience a 10-25-year
reduction in life expectancy.
10. 2017 Data: Approximately 72% of WHO member states had a standalone policy or
plan for mental health.

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Reasons for Poor Status of Mental Health in India

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1. Lack of Awareness and Sensitivity:
a. Social Perception:Mental health issues are often not recognized as legitimate
healthcare concerns. Individuals with mental health problems are viewed as
weak.
b. Stigma and Discrimination: These factors undermine social support
structures. Society frequently labels individuals with mental health issues as
'lunatics,' leading to a cycle of shame, suffering, and isolation.
c. Survey Insights: A 2018 survey revealed that while 87% of respondents
were somewhat aware of mental illness, 71% still used terms associated with
stigma.
2. Lack of Mental Healthcare Personnel: There is a critical shortage of mental
healthcare professionals in India. According to WHO data from 2011, there were
0.301 psychiatrists and 0.047 psychologists for every 100,000 patients. In contrast,
the ratio in most developed countries exceeds 10.
3. Inadequate Treatment: Only 20-30% of individuals with mental illnesses receive
adequate treatment. A significant reason for this wide treatment gap is the lack of
resources.
4. Low Budget Allocation: Developed countries allocate 5-18% of their annual
healthcare budget to mental healthcare, while India allocates roughly 0.05%, the
lowest among G20 countries. Despite rising mental health issues, the Union Ministry
of Health allocated less than 1% of its budget to psychological illnesses in 2022.
5. Changed Lifestyle:
a. Impact of Social Media: Increased use of social media exacerbates stress and
mental illness, especially among young people. Social media detracts from
healthier face-to-face relationships and reduces investment in meaningful
activities, eroding self-esteem through unfavourable social comparisons.

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 b. Shift to Nuclear Families: The transition to nuclear families has reduced
emotional support, as family members are often unavailable during crucial
times.
6. Income Inequalities: Mental health issues are closely linked with poverty. People
living in poverty are at greater risk of mental health conditions, and those with severe
mental health conditions are more likely to fall into poverty due to loss of
employment and increased health expenditure.

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Steps taken
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1. The Mental Healthcare Act, 2017: The Act makes several provisions to improve
the state of mental health in India. The Act rescinds the Mental Healthcare Act, 1987
which was criticised for failing to recognise the rights and agency of those with
mental illness. The Act seeks to ensure the rights of the person with mental illness to
receive care and to live a life with dignity. It provides the Right to Access to
Healthcare: Every person shall have a right to access mental health care and
treatment from mental health services run or funded by the appropriate Government.
It also empowers a person with mental illness to make an advance directive that
states how he/she wants to be treated for the illness.
2. The Act decriminalised suicide stating that whoever attempts suicide will be
presumed to be under severe stress, and shall not be punished for it.
3. Rights of Persons with Disabilities Act, 2017: The Act acknowledges mental
illness as a disability and seeks to enhance the Rights and Entitlements of the
Disabled and provide an effective mechanism for ensuring their empowerment and
inclusion in society.
4. National Mental Health Programme (NMHP):
a. Initiated in 1982 and restructured in 2003: Aims to modernise mental health
facilities and upgrade psychiatric wings in medical institutions.
b. District Mental Health Programme (DMHP): Launched in 1996,
focuses on community mental health services at the primary healthcare level,
covering 716 districts. Provides outpatient services, counselling, psychosocial
interventions, and support for severe mental disorders at community health
and primary health centres.
c. Comprehensive Strategy: Together, NMHP and DMHP form a
comprehensive strategy for mental health care in India.
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 5. National Tele Mental Health Programme (NTMHP):
a. Aims to improve access to quality mental health counselling and care services.
b. National Apex Centre: National Institute of Mental Health and Neuro
Sciences (NIMHANS), Bengaluru, coordinates Tele MANAS activities across
India.
c. State Participation: 25 States/UTs have established 36 Tele Mental Health
and Normalcy Augmentation Systems (MANAS) Cells, handling a total of
63,806 calls on the helpline.
6. NIMHANS and iGOT-Diksha Collaboration:
a. Psychosocial Support and Training: NIMHANS provides support and
training through the iGOT-Diksha platform.
b. Online Training: Conducted by NIMHANS for health workers on the
iGOT-Diksha platform.
7. Ayushman Bharat – HWC Scheme:
a. Part of Ayushman Bharat Programme: The Ayushman Bharat - Health
and Wellness Centres (AB-HWCs) provide a wide range of services, including
preventive, promotive, curative, rehabilitative, and palliative care.
b. Operational Guidelines: Released for Mental, Neurological, and
Substance Use Disorders (MSN) at HWCs under Ayushman Bharat.
8. Kiran: A 24/7 toll-free helpline called Kiran was established by the Ministry of
Social Justice and Empowerment in 2020 to offer support to those dealing with
anxiety, stress, depression, suicide thoughts, and other mental issues.
9. Manodarpan: Students will receive psychosocial help as part of an effort under the
Atmanirbhar Bharat Abhiyan, with the goal of improving the students’ mental health

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and overall well-being. Its components include Advisory Guidelines for students,
teachers and faculty of School systems and Universities along with families; National

Psychosocial Support etc.

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level database and directory of counsellors; Toll-free helpline; Handbook on

Way Forward TI G
1. There is a need to address the deep stigma surrounding such issues which
prevents patients from seeking timely treatment and makes them feel shameful,
isolated and weak.
2. The problem of mental disorders is only the tip of the iceberg. To promote mental
health, it is essential to create a supportive living environment that fosters mental
well-being and enables people to adopt and maintain a healthy lifestyle.
3. Holistic National Mental Health Policies: National mental health policies
should not only focus on mental disorders but also address broader issues like
education, justice, environment, housing, and the health sector, which contribute to
mental health.
4. Early Childhood Interventions: Recognising that many mental disorders start at
an early age, India should aim to improve child development through early childhood
interventions such as nutritional and psychosocial support, and preschool
psychosocial activities to build a healthy community foundation.
5. Empowering Women:
6. Given the increased risk of developmental problems among women, there is a need to
empower them socially and economically by improving access to education and
employment opportunities.
7. Eliminating Discrimination and Violence: Society should be free from
discrimination and violence. Eliminating discrimination based on gender, caste,
disability, and socioeconomic status is crucial to reducing mental disorders. Stress
prevention programmes at workplaces and initiatives addressing the concerns of
indigenous people, migrants, and disaster-affected individuals should be established.

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8. Supporting the Elderly: Social support for elderly people needs to be
strengthened. Developing more day centres and community centres for the aged is
necessary.
9. Strengthening Primary Health Care: Strengthening the treatment of mental
disorders at the primary health care level is key to reducing mental morbidity.
Interventions are needed to prevent the progression of mental disorders from early
signs and symptoms to more serious and chronic cases. There is an urgent need for
simple, easily available diagnostic tests and affordable treatments to provide better
primary health care.
10. Improvement of Mental Health Infrastructure:
a. Enhanced Infrastructure: There is a need to improve infrastructure for
mental health care and treatment.
b. Innovative Models: Implement innovative models to increase the reach of
services and availability of staff.
c. Training ASHAs: Train Accredited Social Health Activists (ASHAs) to
educate and sensitise women and children about mental health issues.
d. Guidance and Support: Community health workers (ASHAs) can guide
individuals to the appropriate mental health experts in their locality.

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Ayushman Bharat-PMJAY
World’s largest health insurance scheme fully financed by the government. Launched in
2018, offering a sum insured of Rs. 5 lakh per family for secondary and tertiary care. Health
Benefit Packages cover surgery, medical and day care treatments, cost of medicines, and
diagnostics.

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1. Beneficiaries:
a. Entitlement-based scheme targeting beneficiaries identified by the latest
Socio-Economic Caste Census (SECC) data.
b. The National Health Authority (NHA) allows States/UTs to use non-SECC
beneficiary family databases with similar socio-economic profiles for tagging
against the leftover (unauthenticated) SECC families.
2. Funding: 60:40 for all states and UTs with their own legislature, 90:10 in Northeast
states and Jammu and Kashmir, Himachal and Uttarakhand, and 100% Central
funding for UTs without legislature.
3. Nodal Agency:
a. National Health Authority (NHA): An autonomous entity under the Society
Registration Act, 1860, for effective implementation of PM-JAY in
collaboration with state governments.
b. State Health Agency (SHA): The apex body of the State Government
responsible for implementing AB PM-JAY in the State.
4. Ayushman Cards:
a. Women: Account for approximately 49% of the total Ayushman cards created
and about 48% of total authorised hospital admissions.
b. As of December 2023: Approximately 28.45 Crore Ayushman Cards have
been created since the scheme's inception, with around 9.38 crore Ayushman
Cards created during the year 2023.
5. Health Coverage:

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 a. 55 crore individuals corresponding to 12 crore families are covered under the
scheme.
b. Many states and union territories implementing AB PM-JAY have further
expanded the beneficiary base at their own cost.

Status of Ayushman Bharat Scheme

1. About 15.5 crore families are covered. It amounts to potential coverage of 50% of
India’s population.
2. 11 states/UTs have pushed for 100% coverage of their respective population.
3. 48% of treatments under the scheme have been availed by women.
4. More than 24 crore Ayushman Cards have been created.
5. It has resulted in savings of more than Rs 1 lakh crore for the beneficiaries which is
often cited as Out of Pocket Expenditure (OOPE).
6. According to the World Bank, the proportion of out-of-pocket expenditure on
healthcare in India, at 50.59 %, is the highest among emerging economies.
7. Hospital Admissions:
a. Total of 6.11 crore hospital admissions, amounting to Rs 78,188 crores were
authorised.
b. In 2023 (Jan-Dec): 1.7 crore hospital admissions worth over Rs 25,000 crores
were authorised.

Attributes to the success of AB-PMJDY scheme

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1. Private sector participation – To elicit the participation of private service

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providers, health benefit packages (HBPs) are given.
2. Quicker settlement of claims – Efforts are being made to settle the claims within

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a defined standard of 15 days. states like Uttarakhand have brought down the claims
settlement time to less than 7 days.
3. Rewarding service providers – Reward to hospitals with a trustworthy record
with an upfront payment of 50% of the claim without adjudication. In 2023, Uttar
Pradesh received 2 awards for excellent work in PM-JAY and on the Ayushman
Bharat Digital Mission (ABDM) from the Centre.
4. Guidance mechanism – Every hospital is mandated to have dedicated Pradhan
Mantri Arogya Mitras (PMAMs) who guide the beneficiaries.
5. Interstate portability – A patient registered in one state is entitled to receive care
in any other state that has an AB-PMJDY programme.
6. This has proved helpful to migrants, especially in emergencies.
7. Digitalised service delivery – NHA has deployed a public dashboard that tracks
implementation on a day-to-day basis.
8. Ensures privacy – Beneficiary details are published without compromising their
privacy and has faceless claim processing.
9. Real-time monitoring – The National Anti-Fraud Unit (NAFU) and state level
Anti-Fraud Units oversee anti-fraud incidences.
10. Artificial Intelligence (AI) and Machine Learning (ML) technologies are used to
detect suspicious transactions/potential frauds. Aadhaar-based authentication for
card creation and registration for treatment has been mandated.
11. Feedback mechanism – The NHA’s call centre makes calls to every beneficiary
within 48 hrs of discharge to verify the quantity and quality of the treatment.
12. Inclusive treatment –Around 50 packages were designed specifically for the
transgender community, including packages on Sex Reassignment Surgery (SRS).
13. Holistic treatment – It provides cashless secondary and tertiary inpatient care for
almost all health conditions to its beneficiaries.

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What issues were noted by the CAG report for 2018 to
2021?
1. Registration of beneficiaries - The identification of beneficiaries based on the
SECC could be irrelevant by now.
2. The CAG audit shows that matching of beneficiaries with the SECC in the online
portal was not done and registrations and rejections of applications were done in an
arbitrary manner.
3. The audit brought to light that there were large numbers of beneficiaries registered
against the same mobile number or Aadhar.
4. Malpractices - The auditors found large scale corruption in insurance claims
settlement.
5. Hospital empanelment done without checks - An Empanelled Healthcare
Provider (EHCP) has to fulfil criteria like the presence of round-the-clock support
systems like pharmacy, blood bank, laboratory, dialysis unit, ICU care etc. Many
hospitals after being empanelled for a certain set of fixed services, failed in providing
them.
6. Missing hospitals - The existence of hospitals in the empanelled list did not
necessarily translate into even their existence in the scheme
7. Shortage of infrastructure & personnel - Shortage of healthcare infrastructure,
doctors and equipment in many States and UTs.
8. PM-JAY focuses on secondary and tertiary care, taking away the attention from
primary care and public health-related investments.

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Other Challenges in Implementing Ayushman Bharat
1. Financial:
a. Economic Sustainability: Ensuring the economic sustainability of
such a large-scale scheme is a significant challenge.
b. Loss-Making Rates: Proposed package rates under NHPS for
various treatments are considered loss-making by hospitals.
c. State Participation: Not all states and Union Territories can raise
their own share, with some not even joining the scheme.
d. Funding Challenges: Without adequate budgetary commitments,
pooling financial risk for such a large population through insurers or
state-run trusts/societies remains uncertain.
2. Human Resource:
a. Limited and Uneven Distribution: Up to 40% of health worker
posts are vacant in some states, creating a significant challenge.
b. Shortage of Doctors: Most primary health care centres face a
perennial shortage of doctors, and even district hospitals lack
specialists.
3. Neglect of Primary Health Care:
a. Overemphasis on Secondary and Tertiary Care: The scheme
may neglect primary healthcare, which is essential for sustainable
quality healthcare.

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 b. Lack of Outpatient Care: Ayushman Bharat does not provide
out-patient department care support, a major component of health
expenditures.
c. Impact on Government and Small Hospitals: Fiscal incentives
for private sector hospitals in deficit areas could harm
government-owned and small hospitals, leading to cost escalations
due to the consolidation of tertiary hospitals by foreign financial
conglomerates and private equity funding agencies.
4. Technical and Administrative:
a. IT Network for Cashless Treatment: A large-scale Information
Technology network for cashless treatment needs to be established
and validated.
b. Administrative Upgrades: State governments need to upgrade
administrative systems to address efficiency and accountability issues
in secondary and tertiary public hospital infrastructure.
c. Cooperative Federalism: The refusal of West Bengal, Telangana,
Delhi, and Odisha to join Ayushman Bharat raises concerns about
cooperative federalism. States are responsible for hospital services and
have their own schemes for financial risk protection.

Way Forward for Ayushman Bharat

1. Strengthening Public Hospitals:

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a. Universal Healthcare: Urgently strengthen publicly funded hospitals to

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b. Preventive and Primary Care: Reduce the pressure on secondary and
tertiary hospitals by investing in preventive and primary care facilities. The

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150,000 health and wellness centres of the National Health Protection
Mission can play a crucial role in this regard.
2. Universal Health Coverage Roadmap: Public Sector Infrastructure: Prioritise
drawing up a roadmap for universal health coverage through continuous upgrading
of public sector infrastructure.
3. Increased Public Funding: Increase public funding and provide flexibility in
financial transfers from the centre to states to improve the performance of
state-operated public systems.
4. Quality Assurance: Increased public spending can enhance quality assurance in
both public and private sectors through effective regulation and oversight.
5. Cost Containment and Efficiency: Introduce specific methods to contain costs,
improve spending efficiency, increase accountability, and monitor the impact of
expenditures on health.
6. Broad Coverage of Ayushman Card Distribution: The National Health
Authority (NHA), along with state counterparts, should aim to provide every possible
beneficiary with an Ayushman Card.
7. Private Hospital Participation:Encourage more private hospitals to join as
empanelled hospitals under the Ayushman Bharat Scheme.
8. Integrated Approach through Public and Private Collaboration: Foster
collaboration between public and private sectors to ensure comprehensive healthcare
delivery and access.

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National Digital Health Mission (NDHM)
The Government of India aims to develop an integrated digital health infrastructure through
NDHM. This mission seeks to create a digitally networked ecosystem of stakeholders
supporting Universal Health Coverage.

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Components of NDHM:
1. Health ID: Unique identification for patients to manage health data.
2. Digi Doctor: A single repository of enrolled doctors nationwide.
3. Personal Health Records: Electronic records of individuals' health-related
information.
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 4. Health Facility Registry: A single repository of all health facilities.
5. E-pharmacy: Facilitates easy availability and delivery of medicines based on
prescriptions.
6. Tele-medicine: Remote access to diagnosis and treatment through technology.

Benefits of NDHM:
1. Empowerment of Patients: Provides constant access to health records and
increases access to doctors through tele-medicine.
2. Efficiency and Effectiveness: Improves health service delivery by providing
doctors with quick access to patients' medical histories.
3. Patient Choice and Transparency: Offers patients choices in availing services
and ensures transparency.
4. Policy Making: Assists policymakers with access to data for understanding trends.
5. Research: Benefits medical researchers through a variety and vastness of data.
6. Benefits for Patients:
a. Storage: Securely store and access medical records.
b. Sharing Information with healthcare providers.
c. Accuracy: Access accurate health information.
d. Access: Remote access to health services.
e. Informed Decision-Making: Empower individuals with accurate
information.

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f. Choice: Access to both public and private health services.
g. Transparency and Accountability: Ensures compliance with guidelines

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7. Benefits for Healthcare Professionals: R
and transparency in service pricing.

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a. Effective Interventions: Better access to patient history for informed
consent and appropriate interventions.
b. Continuum of Care: Integrated ecosystem for better continuity.
c. Faster Processing: Digitizes claims process for faster reimbursement.
d. Ease of Providing Services: Enhances service provision efficiency.
8. Benefits for Policymakers:
a. Informed Decision-Making: Better access to data for informed policy
decisions.
b. Preventive Healthcare: Better data quality for preventive measures.
c. Monitoring and Implementation: Enables demographic-based
decision-making.
9. Benefits for Researchers:
a. Evaluation: Access to aggregated information for program evaluation.
b. Comprehensive Feedback: Facilitates feedback between researchers,
policymakers, and providers.

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Concerns with NDHM:

1. Cost and Compliance Challenges: Both public and private sectors may need to
invest in new software to comply with NDHM guidelines, leading to dilemmas in
transitioning from existing systems like IDSP-HMIS to new ones.
2. Burden on Practitioners: Independent allopathic practitioners and those in the
Indian System of Medicine, who currently do not store patient data, may face
significant burdens and costs.
3. Data Security Risks: Highly decentralised health systems with data storage at
multiple levels could make information vulnerable. Informed consent might be
insufficient given that over 80% of India lacks basic digital literacy (Digital
Empowerment Foundation report).
4. Private Sector Misuse: Potential misuse by private diagnostics, hospitals, and
insurance sectors to avoid obligations.
5. Lack of Statutory Value:It is a policy document issued without any statutory
framework, reducing its enforceability and binding nature.
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 6. Federal Structure:
a. Impact: Health is a state subject in India, and the policy impacts India's
federal structure.
b. Non-Binding: The policy cannot bind states and isn't binding on the
National Health Authority (NHA) enforcing it. The policy can be changed,
impacting its stability.
7. Unclear Guidelines on Data Usage: It is unclear when users will be notified each
time their data is used and who will enforce this notification.
8. Erasure of Data:The policy provides only certain circumstances where personal
data can be erased, limiting user control over their data.
9. No Right to Be Forgotten:Patients can request data erasure if withdrawing
consent, but requests can be denied, limiting control over their own data.
10. Ambiguity:The role of a consent manager is not clearly defined, causing confusion
about their function and enforcement.
11. Privacy Issues: Certain clauses allow for the collection and processing of personal
and sensitive data, but it is unclear who has access to this data.
12. Mass Surveillance: The "womb to tomb" health identity aims to improve patient
care but raises concerns about mass surveillance.

Way forward
1. Increase Healthcare Expenditure: India's public healthcare spending is less
than 1% (National Health Profile, 2018). The National Health Policy aims for 2.5% by
2025.

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2. Improve Doctor-Patient Ratio: WHO recommends a 1:1000 ratio, but it is

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1:11082 in India for each government allopathic doctor (Directorate of State Health

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3. Upgrade Rural Doctor Availability: Primary Health Care centres need 3000
more doctors, with 1974 centres lacking a doctor (Rural Health Statistics, 2017).
Secondary and tertiary healthcare is nearly absent in rural areas.
4. Enhance Infrastructure: There is one government hospital bed for every 2,046
people (National Health Profile, 2018), necessitating urgent upgrades.
5. Reduce High Out-of-Pocket Expenditure: More than 70% in India. Generic
medicines, affordable primary healthcare, and Ayushman Yojna can help address
this.

Satyanarayana committee 2018 its report named National Digital Health

Blueprint (NDHB)
1. The Satyanarayana committee recommended drafting a National Digital Health
Blueprint to lay down the building blocks and action plan for a digital health
mission.
2. National Digital Mission Blueprint recommended the establishment of an entity
called National Digital Health Mission to provide for a digital healthcare
ecosystem for healthcare services across the country.
3. Establishment of Digital Health Systems. Core digital health data managed by
these systems
4. Creation of Registries: It will have all credible data of clinical establishments,
healthcare professionals, health workers, drugs and pharmacies.
5. Enforcement of adoption of open standards by all national digital health
stakeholders
6. Enterprise-class health application systems: The aim will be to achieve
health-related Sustainable Development Goals (SDGs).
7. Adoption of cooperative federalism while coordinating with states and union
territories.

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 8. Promotion of private players’ participation along with the public health authorities
9. Making healthcare services portable nationally.
10. Promotion of Clinical Decision Support (CDS) Systems by healthcare professionals.

NDHM is one of many steps needed to address India’s healthcare gap. Concerns related to
data safety and private sector misuse must be prioritised. A multi-dimensional approach,
including increased expenditure as per the National Health Policy and investment in quality
medical education, is essential.

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ASHA (Accredited Social Health Activist)
Workers

About:
1. Community Volunteers: ASHA workers are volunteers from within the
community, trained to provide information and help people access various
government healthcare schemes.
2. Demographic: Primarily married, widowed, or divorced women between 25 and 45
years old from the community.
3. Global Recognition: The WHO has recognized India's 10.4 lakh ASHA workers as
'Global Health Leaders' for their role in connecting communities to government
health programs.

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Role of ASHA Workers:
1. Bridge to Healthcare: They connect marginalised communities with facilities such
as primary health centres, sub-centres, and district hospitals.
2. Establishment: Their role was established in 2005 under the National Rural Health
Mission (NRHM).
3. Coverage Goal: The aim is to have one ASHA for every 1,000 persons, or per
habitation in hilly, tribal, or sparsely populated areas.
4. Immunisation: ASHA workers ensure and motivate children to get immunised.

Challenges Faced by ASHA Workers:

1. Frontline Inequality: ASHA workers were not treated on par with doctors despite
being frontline workers during the pandemic.
2. Lack of PPE: They were not provided with adequate PPE while performing tasks
like contact tracing and interacting with newly infected cases, posing a risk to
themselves and their families.
3. Community Stigma: This risk resulted in stigma and discrimination from the
community, labelling them as high-risk COVID-19 contacts.
4. Violence: There have been multiple instances of violence against ASHAs and their
families.

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 5. Testing and Treatment: ASHAs did not have access to priority or free testing, and
if they tested positive for COVID-19, they did not receive support for treatment.

Suggestions:
1. Recognition: The government and communities should recognize ASHAs' work
through financial and non-financial incentives.
2. Institutional Mechanisms: Develop mechanisms to incorporate ASHAs’
experiences, needs, and realities related to class, caste, and gender into policymaking.
3. Guidelines: Develop and disseminate clear, concise guidelines for ASHAs in a
timely manner.
4. Capacity Building: Establish a strategy for capacity building, particularly in
technology use, and initiate supervision initiatives for ASHAs.
5. Support Systems: Develop support systems to ensure the physical and mental
well-being of ASHAs.
6. Health System Reforms: Initiate broader health system reforms for ASHAs,
including policies for fair recruitment, retention, financial protection, leave
management, protection against sexual harassment, physical and mental health
protection, and stigma prevention, with clear accountability at all levels.
7. Program Convergence: Ensure convergence with vertical programs such as
livelihoods and nutrition to complement the work of ASHAs.

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Preventative And Primary healthcare
healthcare
The preventative healthcare sector, including fitness, wellness, foods and supplements, early
diagnostics, and health tracking, is expected to reach $197 billion by 2025 in India.

Importance of Primary Health Care

Primary health care is essential for a welfare state and plays a crucial role in promoting
sustainable development. It ensures that all citizens have access to essential health services
and serves as the foundation for a healthy and productive society.

Significance of Primary Health Care for Sustainable

Development:
1. Health as a Human Right:
● Moral Imperative: Primary health care ensures every individual has access
to basic health services, aligning with the concept of health as a human right,
which emphasises that everyone should have the opportunity to achieve the

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highest possible level of health. Eg. Kerala's primary health care system
operationalizes health as a human right. Its strong network of health centres

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and community health workers ensures access to basic health services for all,
contributing to impressive health indicators.

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2. Equitable Access to Health Services:
● Socio-Economic Equity: A robust primary health care system ensures
equitable access to health services for all citizens, regardless of their
socio-economic status. Eg. Tamil Nadu provides equitable health service
access through an extensive network of primary health centres and
sub-centers, even in remote areas. The "Amma Clinic" initiative offers free
essential health services, emphasising equity in access.
3. Preventive Care and Cost-Effectiveness:
● Efficient Resource Allocation: By focusing on cost-effective preventive
measures, primary health care fosters sustainable development and efficient
resource allocation. Eg. Delhi's Mohalla Clinics focus on preventive care and
cost-effectiveness. They provide free services, including preventive health
care, diagnostics, and basic drugs, helping prevent disease escalation,
reducing the burden on tertiary care, and enhancing cost-effectiveness.
4. Improved Health Outcomes:
5. Better Health Indicators: Access to primary health care services is directly linked
to better health outcomes, such as reduced infant mortality, increased life expectancy,
and lower disease prevalence.
6. Economic Productivity:
● Healthy Workforce: Primary health care ensures access to essential health
services, creating a healthy and productive workforce critical for sustainable
development.
7. Social Cohesion and Stability:
● Inclusive Health Services: Primary health care promotes social cohesion
and stability by addressing the health needs of all citizens, including
vulnerable and marginalised populations.

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Importance of Preventive Healthcare
1. Preventive healthcare plays a crucial role in identifying health issues early when
they are more manageable and less expensive to treat. Diseases like cancer, diabetes,
and heart disease have significantly better treatment outcomes if detected in their
initial stages before symptoms appear.
2. Regular screenings and checkups are essential to prevent the development
of diseases and health issues. Initiatives such as cancer screenings, vaccination
programs, health risk assessments, and lifestyle counselling help identify and address
risk factors proactively.
3. Investing in preventive care leads to long-term savings in healthcare costs.
By addressing minor health issues early, we can prevent them from escalating into
major illnesses or disabilities that require extensive and costly treatments. Routine
physicals, immunizations, and the management of chronic conditions help avoid
substantial future expenses.
4. Early intervention improves overall health and quality of life. Addressing
health problems promptly means greater productivity, fewer absences from work or
school, and a higher quality of life.
5. Preventive care encourages healthy behaviours and lifestyle changes that
provide lifelong benefits. Programs for nutrition counselling, smoking cessation,
and exercise guidelines help establish habits that promote ongoing wellness and
disease prevention.
6. Widespread preventive healthcare programs enhance population health. Public

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health initiatives aimed at reducing smoking and obesity rates benefit entire
communities and help control rising healthcare costs.

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7. By ensuring equitable access to health services, promoting preventive care, improving
health outcomes, and fostering economic productivity and social cohesion, primary

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health care lays the foundation for a healthy, inclusive, and prosperous society
capable of sustainable development and growth.

Preventing Disease: Classification of Preventive

Measures
Preventing disease relies on anticipatory behaviours that can be classified into primal,
primary, secondary, tertiary, and quaternary preventive measures.

1. Primal Prevention: Recognizing that epigenetic modifications begin at conception,

primal prevention is proposed as a distinct category of health promotion. Primordial
prevention involves strategies aimed at stopping risk factors from emerging early in
life.
2. Primary Prevention: These techniques aim to prevent the occurrence of illness by
either removing disease agents or boosting resistance to disease. Examples include
vaccinations, maintaining a healthy diet and exercise routine, and quitting smoking.
3. Secondary Prevention: These techniques involve identifying and treating diseases
before symptoms appear. Examples include cancer screenings and treating
hypertension, a risk factor for various cardiovascular diseases.
4. Tertiary Prevention: These techniques use treatment and rehabilitation to reduce
the impact of symptomatic diseases, such as disability or mortality. Examples include
medical interventions that prevent the progression or spread of illness.
5. Quaternary Prevention: These techniques aim to reduce or prevent the effects of
unnecessary or excessive interventions within the health system, including breaches
of human rights.
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Issues with Preventive Healthcare in India
1. Lack of Awareness and Education: Many people in India are unaware of the
benefits of preventive healthcare. Eg. According to the National Family Health
Survey (NFHS-5), only 50% of women aged 15-49 years are aware of the necessity of
regular health check-ups.
2. Inadequate Infrastructure: Preventive healthcare services, such as regular
screenings and vaccinations, are often unavailable in rural and remote areas. As per
the Rural Health Statistics 2021, India faces a shortfall of 83% in specialist doctors at
Community Health Centres (CHCs).
3. Financial Constraints: High out-of-pocket expenditure limits access to preventive
services for many individuals. According to the National Health Accounts (NHA)
Estimates for India (2017-18), out-of-pocket expenditure constitutes 58.7% of the
total health expenditure.
4. Low Public Health Expenditure: India’s expenditure on public health is low
compared to global standards. The Economic Survey 2021-22 highlighted that India
spends about 1.26% of its GDP on healthcare, which is significantly lower than the
global average of 6%.
5. Cultural and Social Barriers: Cultural beliefs and social norms often prevent
people from seeking preventive care. Eg. In some communities, there is a stigma
associated with certain health screenings, such as those for sexually transmitted
infections.

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6. Inefficient Health Information Systems: Lack of robust health information

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systems hampers the tracking and monitoring of preventive health initiatives. Eg.
The World Health Organization (WHO) has highlighted the need for improved health

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information systems in India to better manage health data.
7. Urban-Rural Disparities: There is a significant gap in the availability and quality
of preventive healthcare services between urban and rural areas. The NFHS-5 data
indicates that immunisation coverage is significantly higher in urban areas (64%)
compared to rural areas (52%).
8. Limited Access to Quality Healthcare Professionals: Shortage of trained
healthcare professionals affects the delivery of preventive services. According to the
World Bank, India has only 0.8 physicians per 1,000 people, which is below the WHO
recommended standard of 1 physician per 1,000 people.
9. Inconsistent Policy Implementation: Preventive healthcare policies are often
inconsistently implemented across states. Eg. The effectiveness of the National
Health Mission (NHM) varies widely across different states, with some states lagging
in key health indicators.
10. Limited Preventive Healthcare Programs: The scope and reach of existing
preventive healthcare programs are often limited.Eg. The coverage of cancer
screening programs is still low, with the Indian Council of Medical Research (ICMR)
reporting that only 12.5% of eligible women undergo regular cervical cancer
screenings.

Steps to strengthen preventive healthcare

1. The government should implement a healthcare system geared towards prevention,
screening, early intervention, and new treatment modalities to reduce the burden of
chronic disease.
2. An integrated preventive healthcare system that will raise awareness and enable the
detection and diagnosis of diseases.

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3. Having access to inexpensive, fair healthcare services. optimum use of government
funds and increased government investment in health care.
4. Corporates should be encouraged to take preventative steps for their employees.
5. The government should implement mandatory routine health checks through
healthcare programs starting at age 25.
6. Health education that focuses on illness prevention via awareness and knowledge
about treatment options must also be regarded as necessary health care.
7. Having a sufficient quantity, diversity, and infrastructure of health workers.
8. Need to establish personal health records and promote population disease screening.
9. Enhancing local hospitals’ ability to detect and treat Non-Communicable Diseases.
10. The need to refocus on enhancing preventative healthcare services is seen in
programs like “Health for All” and “The National Health Assurance Mission” along
with other healthcare schemes by the government.

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Universal Health Coverage (UHC)
Universal Health Coverage (UHC) ensures that all individuals and communities receive the
health services they need without suffering financial hardship. This includes a full spectrum
of essential, quality health services from health promotion to prevention, treatment,
rehabilitation, and palliative care across the life course.

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Importance of UHC:
1. Social Benefits:
a. Access to Services: Enables everyone to access services that address the
most significant causes of disease and death.
b. Quality of Services: Ensures the quality of these services is high enough to
improve the health of the recipients.
c. Human Capital Formation: Provides affordable, quality health services,
particularly benefiting women, children, adolescents, and those with mental
health issues, representing a long-term investment in human capital.
2. Economic Benefits:
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 a. Financial Protection: Shields people from the financial consequences of
paying for health services out of their own pockets.
b. Poverty Reduction: Reduces the risk of people being pushed into poverty
due to unexpected illness, requiring them to use life savings or sell assets.
c. Long-term Economic Development: Good health enables children to
learn and adults to earn, aiding in long-term economic development.
d. Sustainable Development Goals (SDG): Especially aligned with SDG
3.8, which aims to achieve universal health coverage.

Barriers to Achieving UHC:

1. Economic:
a. Resource Allocation: Less than 2% of GDP is allocated to the health sector.
b. Infrastructure: Rural-urban divide in terms of manpower and physical
infrastructure.
c. Skilled Professionals: India’s doctor-patient ratio is 1:1456, below the
WHO standard of 1:1000.
d. Out-of-Pocket Expenditure: 65% of health expenditure in India is
out-of-pocket (Economic Survey 2020-21).
2. Social:
a. Gender Inequality: Women are less likely to be in paid employment,
reducing their chance of availing health benefits.
b. Ageing Population: Increases the burden of diseases and dependency.

UHC.
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c. Social Determinants of Health: Poverty, illiteracy, alcoholism hinder

3. Governance:

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a. Policy Paralysis: Lack of inter-sectoral coordination and political
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b. Management Issues: Fragmented, unregulated healthcare delivery
systems.
c. State Subject: Health is a state subject, leading to coordination challenges.
4. Technological:
a. Digital Deficiency: Lack of processed healthcare data and digital storage.
b. Equipment: Low availability of basic medical equipment.
c. Research: Inadequate multi-sectoral research for healthcare.

Status in India:
1. Constitutional:
a. Fundamental Rights: Article 21 obligates the state to safeguard the right to
life.
b. Directive Principles of State Policy (DPSP): Articles 41, 42, 47 state the
duty of the state to ensure health and nutrition for citizens, especially women,
children, and weaker sections.
2. Policy Measures:
Jan Arogya Yojana: Ayushman Bharat PM-JAY is the largest health assurance
scheme, providing a health cover of Rs. 5 lakhs per family per year for secondary and
tertiary care hospitalisation to over 10.74 crore poor and vulnerable families, forming
the bottom 40% of the Indian population.

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Government Steps for implementing UHC in Healthcare
sector
1. National Health Policy (NHP) 2017: Allocating resources of up to two-thirds or
more to primary care for achieving “the highest possible level of good health and
well-being, through a preventive and promotive healthcare orientation”.
2. A 167% increase in allocation for the Pradhan Mantri Jan Arogya Yojana
(PMJAY) — the insurance programme which aims to cover 10 crore poor
families for hospitalisation expenses of up to ₹5 lakh per family per annum.
3. The government’s steps to incentivise the private sector to open hospitals in
Tier II and Tier III cities.
4. Individual states are adopting technology to support health-insurance schemes.
Example: Remedinet Technology (India’s first completely electronic cashless health
insurance claims processing network) has been signed on as the technology partner
for the Karnataka Government’s recently announced cashless health insurance
schemes.

Way Forward:
1. Economic:
a. Per Capita Expenditure: Improve spending on health to 5-6% of GDP.
b. Non-Medical Preventive Health: Remove constraints like
unemployment, incomes, food security, water, and sanitation.
2. Social:
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a. Women Empowerment: Correlates directly with family health.

and elderly neglect.

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b. Ending Social Evils: Campaigns to reduce issues like alcoholism, abuse,

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c. Addressing Regional Disparities: Incentivize rural areas for healthcare
infrastructure.
3. Governance:
a. Health-Cadre Management: Improved management through public
health management cadre.
b. Performance Incentives: Financial rewards for states showing improved
health outcomes.
c. Education Curricula: Reorient medical education towards public health.
d. Policy Focus: Target neglected areas like rural, tribal, and inaccessible
regions.
4. Technological:
a. Digital Health: Use of telemedicine to bridge geographical gaps.
b. Innovation: Machine learning and AI to transform healthcare delivery.
5. Best Practices:
a. Chile: UHC is financed through a mandatory tax.
b. Ghana: Revenues from a 2.5% increment in consumption taxes.
c. Japan: Government subsidies payments on plans that incur higher costs.

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Non-Communicable Diseases (NCDs)
Global:
● NCDs accounted for 74% of deaths globally in 2019.
● NCDs now form 7 of the world’s top 10 causes of death, up from 4 in 2000.

India:
● NCDs cause 65% of deaths in India, with ischemic heart diseases, COPD, and
stroke being leading causes.
● The contribution of NCDs to total deaths increased from 37% to 61% between 1990
and 2016.
● NCDs are expected to cost India $4.5 trillion by 2030 due to productivity losses.

Risk Factors:
1. Behavioural Factors:
a. Tobacco Use: Leading global risk factor for illness and death from major
NCDs.
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b. Harmful Use of Alcohol: Causes heart diseases, liver diseases, and a range
of mental and behavioural disorders.

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c. Physical Inactivity: Increases the risk of stroke, hypertension, and

d. Unhealthy Diet: Contributes to raised blood pressure and increased risk of

heart disease and stroke.
2. Environmental Factors:
a. Air Pollution: Causes millions of deaths due to ischemic health disease,
chronic lung diseases, and cancers.
b. UV Radiation: Causes skin cancer due to ozone layer depletion.
3. Non-Modifiable Factors: Include age, sex, and genetic make-up, affecting the
effectiveness of many prevention and treatment approaches.
4. Metabolic Factors: Raised blood pressure, overweight/obesity, raised blood
glucose, and cholesterol levels.
5. Other Factors:
a. Urbanisation: Changes people’s way of living and increases exposure to
shared risk factors.
b. Globalisation: Increases risk factors through marketing and sedentary
lifestyles.
c. Educational Levels: Lower education levels correlate with higher
prevalence of NCDs.
d. Poverty: Under-nutrition and low birth weight increase the risk of
cardiovascular disease and diabetes.
6. Aggravated Impact of COVID-19:
a. Mental Health Impact: Stress from avoiding infection and physical
distancing recommendations.
b. Disruption in Care: Routine chronic care and medication disrupted due to
COVID-19 response.

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Impact of NCDs:
1. Economic Impacts:
a. Poverty: High out-of-pocket expenditure and low productivity create a
vicious cycle.
b. National Income: Productivity losses decrease national income.
c. Household Income: High cost of NCD-related healthcare reduces
household income.
2. Social Impacts:
a. Social Inequity: Out-of-pocket payments for health care increase the risk of
impoverishment.
b. Hunger and Education: NCDs force cuts in spending on food and
education, impacting family assets.
c. Healthcare System: High hospital admission rates and healthcare resource
consumption strain the system.
3. Health Impacts: NCD-related deaths from cancer, diabetes, and other diseases are
significant.

Steps Taken:
1. National Steps:
a. National Programme for Prevention and Control of Cancer, Diabetes,
Cardiovascular Disease and Stroke (NPCDCS) 2010: Infrastructure and
screening initiatives.

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b. National Health Policy 2017: Aims to reduce premature mortality from

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c. National Action Plan: Adopted WHO’s Global Action Plan for NCDs.
d. WHO Framework for Tobacco Control: Aimed at reducing tobacco
demand.
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e. Ayushman Bharat: Establishing health and wellness centres.
f. Indian Hypertension Management Initiative (IHMI): Collaborative
project to strengthen the CVD component of NPCDCS.
2. International Steps:
a. Global Action Plan for NCDs 2013-2020: Developed by WHO with nine
global targets.
b. Global NCD Network (NCDnet): Formed by WHO in 2009.
c. NCD Alliance: Partnership founded in 2009 to represent cardiovascular
diseases, diabetes, cancer, and chronic respiratory disease.
d. United Nations Interagency Task Force on the Prevention and
Control of NCDs (UNIATF): Established in 2013 to support governments in
tackling NCDs.

Way Forward
Risk Factors and Interventions:
1. Reduce Tobacco Use:
a. Tax: Increase excise taxes on tobacco products.
b. Packaging: Large graphic health warnings.
c. Advertising: Enact comprehensive advertising bans.
d. Smoke-Free Public Places: Eliminate exposure to second-hand smoke.
e. Education: Effective mass media campaigns.
2. Reduce Harmful Use of Alcohol:
a. Tax: Increase excise taxes on alcohol.
b. Advertising: Enforce advertising bans.
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 c. Availability: Restrict alcohol availability.
d. Education: Mass media campaigns.
3. Reduce Unhealthy Diet:
a. Reformulate Food: Reduce salt intake through food reformulation.
b. Supportive Environments: Establish environments reducing salt intake.
c. Education: Public campaigns on healthy eating.
d. Packaging: Front-of-pack labelling to reduce salt intake.
4. Reduce Physical Inactivity: Community-wide campaigns promoting physical
activity.
5. Manage Cardiovascular Disease and Diabetes:
a. Therapy and Counseling: For individuals with high risks.
b. Vaccination: Against human papillomavirus.
c. Screening: For cervical cancer in women aged 30-49.

Other Steps:
1. Living and Working Conditions: Ensure conducive conditions for all, including
clean water, air, and social protection.
2. ‘Health-in-all Policies’ Approach: Focus on gender-responsive and human
rights-focused policies aligned with SDGs.
3. Community Outreach and Empowerment: Engage local organisations to
identify inequities and solutions.
4. Reliable Health Data: Collect disaggregated data by key parameters like sex,
geography, and education.

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5. WHO-Supported Health Information Platform: Provide integrated data on

6. Best Practices:
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country progress across health indicators.

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a. Zambia:Integrated national HIV services and cervical cancer prevention.
b. Tuvalu: Red Cross Society implemented a pilot project for health, disaster,
and climate change needs.

These measures highlight the comprehensive steps required to address the challenges and
improve health service delivery through NDHM and other health initiatives.

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Tribal Health
Tribal people account for 8.6% of the country’s population and their problems like health,
poverty are still an issue. The health status of India’s tribal communities is in need of special
attention. Being among the poorest and most marginalised groups in India, tribals
experience extreme levels of health deprivation. The tribal community lags behind the
national average on several vital public health indicators, with women and children being the
most vulnerable.

Main Tribal Health Issues

1. Malnutrition: Tribal people often lack sufficient food or the right kind of food,
leading to hunger, stunting, wasting, anaemia, and deficiencies in vitamins and
minerals. Malnutrition- The percentage of underweight ST children is around 40%
in 2015-16. Tribal constitutes 8% of India’s total population but they have 30% of all
cases of Malaria. Prevalence of TB in the rest of India is 256 per 100,000 cases but in
tribals, it is 703 cases per 100,000 almost three times.
2. Mortality: There are improvements in parameters but there is certainly a gap
between tribals and the rest of India.Under-five mortality rate declined from 135 in
1988 to 57 in 2014.Under-five child mortality for the rest of India was around 39 in
2014.

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3. Communicable Diseases: Higher susceptibility to infectious diseases such as
malaria, tuberculosis, leprosy, HIV/AIDS, diarrhoea, respiratory infections, and

4. Non-Communicable Diseases:
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vector-borne diseases due to poor sanitation, hygiene, and limited healthcare access.

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a. Increased risk of chronic diseases like diabetes, hypertension, cardiovascular
diseases, cancer, and mental disorders.
b. A study shows about 13% of tribal adults have diabetes, and 25% have high
blood pressure.
5. Addictions:
a. High rates of tobacco use, alcohol consumption, and substance abuse
contribute to health issues.
b. Over 72% of tribal men aged 15–54 use tobacco, and more than 50% consume
alcohol, compared to 56% and 30% of non-tribal men, respectively.

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Challenges in Tribal Health
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a. Inadequate healthcare facilities and infrastructure in tribal areas.
b. Limited access to clean water and sanitation facilities.

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2. Shortage of Medical Professionals:
a. Few doctors, nurses, and healthcare professionals in tribal regions.
b. Difficulty attracting and retaining skilled healthcare personnel in remote
areas.
c. Imbalance in the distribution of healthcare professionals, with a
concentration in urban areas.
3. Connectivity and Geographic Barriers:
a. Remote locations and difficult terrain hinder access to healthcare services.
b. Poor roads, transportation facilities, and communication networks.
c. Challenges in reaching tribal communities during emergencies and providing
timely medical assistance.
4. Affordability and Financial Constraints:
a. Limited financial resources and low-income levels among tribal communities.
b. Inability to afford healthcare expenses, including treatments, medicines, and
diagnostics.
c. Lack of awareness about available healthcare schemes and insurance options.
5. Cultural Sensitivities and Language Barriers:
a. Unique cultural practices and beliefs affect healthcare-seeking behaviour.
b. Language barriers between healthcare providers and tribal communities lead
to miscommunication and inadequate care.
c. Lack of culturally sensitive healthcare services that respect tribal customs and
traditions.
6. Limited Access to Essential Services:
a. Insufficient availability of essential healthcare services, such as maternal and
child health, immunisation, and preventive care.
b. Inadequate access to specialised care, diagnostic facilities, and emergency
medical services.
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 c. Limited awareness about health issues, preventive measures, and healthcare
rights among tribal communities.
7. Inadequate Funding and Resource Allocation:
a. Limited allocation of funds for healthcare in tribal areas.
b. Insufficient investment in healthcare infrastructure, equipment, and
technology.
c. Lack of dedicated funding for addressing tribal health challenges and
implementing targeted interventions.

GoI’s Report on Tribal Health in India

■ In 2018, an expert committee, constituted jointly by the Ministry of Health
and Family Welfare and Ministry of Tribal Affairs released the first
comprehensive report on Tribal Health in India.
■ Recommendations of the Report:
○ Implement Universal Health Assurance under the National
Health Policy (2017) in tribal areas.
○ Utilise Aarogya Mitra, trained local tribal youth, and ASHA
workers for primary care in tribal communities with support from the
gram sabha.
○ Provide financial protection through government medical insurance

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schemes for secondary and tertiary care.
○ Introduce ST Health Cards for tribal people living outside scheduled

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areas to facilitate access to benefits at any healthcare institution.
○ Implement a Tribal Malaria Action Plan in tribal-dominated

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districts under the National Health Mission.
○ Strengthen Home-Based Newborn and Child Care (HBNCC)
programs to reduce infant and child mortality.
○ Enhance food security and strengthen Integrated Child Development
Services (ICDS) to address malnutrition.
○ Publish a state of tribal health report every three years and establish a
Tribal Health Index (THI) to monitor tribal health.
○ Establish a National Tribal Health Council as an apex body, along
with Tribal Health Directorate and Tribal Health Research Cell, at both
central and state levels.

Way Forward
1. Addressing Disparities:Focus on reducing the disparity in health-seeking
behaviour and healthcare delivery among tribal populations.
2. Recognizing Traditional Healers:Acknowledge and integrate the services
provided by traditional healers within tribal communities.
3. Empowering Tribal Communities:Implement health literacy programs to
empower tribal communities to make informed health decisions.
4. Recruitment and Retention of Healthcare Professionals:Develop targeted
strategies to attract and retain healthcare professionals in tribal regions.
5. Improving Infrastructure:Invest in the development of road networks,
transportation facilities, and communication networks to enhance connectivity and
access to healthcare.
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6. Financial protection through government medical insurance schemes should be
provided to tribals for secondary and tertiary care.
7. A state of tribal health report should be published every 3 years and placed before
the nation.

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Antimicrobial resistance
Antimicrobial resistance occurs when microorganisms (including bacteria, viruses, fungi,
and parasites) develop the ability to withstand the effects of antimicrobial drugs, such as
antibiotics, antifungals, antivirals, antimalarials, and anthelmintics, which are designed to
treat infections.

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Reasons for the Spread of Antimicrobial Resistance

(AMR)
1. High Prevalence of Communicable Diseases:The high burden of diseases like
tuberculosis, diarrhoea, and respiratory infections necessitates frequent
antimicrobial treatment.
2. Overburdened Public Health System:Limited laboratory capacity for
aetiology-based diagnosis and targeted treatment due to an overburdened public
health system.
3. Poor Infection Control Practices:Hygiene lapses in hospitals and clinics
facilitate the spread of resistant bacteria.
4. Injudicious Use of Antimicrobials: Overprescribing by doctors under patient
pressure, self-medication, incomplete antibiotic courses, and unnecessary use of
broad-spectrum antibiotics create selective pressure for resistant bacteria.
5. Easy Access to Antibiotics: Unregulated over-the-counter availability and
affordability of antibiotics lead to self-medication and inappropriate use.

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 6. Lack of Awareness: Low public understanding of AMR and proper antibiotic use
promotes misuse.
7. Limited Surveillance: Inadequate monitoring systems hinder the tracking and
understanding of AMR's scope.

Implications of the Spread of Antimicrobial Resistance

(AMR)
1. Healthcare Impact: AMR can make previously effective antibiotics ineffective
against bacterial infections. This complicates the treatment of common illnesses like
pneumonia, urinary tract infections, and skin infections, resulting in prolonged
illnesses, more severe symptoms, and increased mortality rates.
2. Increased Healthcare Costs: Treating resistant infections often requires more
expensive and prolonged therapies, extended hospital stays, and sometimes more
invasive procedures. This leads to higher healthcare costs for individuals, healthcare
systems, and governments.
3. Challenges in Medical Procedures: AMR makes certain medical procedures
riskier. Surgeries, cancer chemotherapy, and organ transplants become more
hazardous due to the increased risk of infections resistant to standard antibiotics.
4. Limitations in Treatment Options: As resistance grows, the available arsenal of
effective antibiotics diminishes. This limitation in treatment options may lead to a
scenario where previously manageable infections become untreatable, reverting
x
medicine to a pre-antibiotic era where common infections could be fatal.
Y
Measures Taken to Address AMR E R
TI G
India:
1. National Programme on AMR Containment: Launched in 2012, this
programme has strengthened the AMR Surveillance Network by establishing
laboratories in state medical colleges.
2. National Action Plan on AMR: Launched in April 2017, it focuses on a One
Health approach, involving various stakeholder ministries and departments.
3. AMR Surveillance and Research Network (AMRSN): Established in 2013 to
generate evidence and capture trends and patterns of drug-resistant infections in the
country.
4. AMR Research & International Collaboration:
a. The Indian Council of Medical Research (ICMR) has initiated collaborations
to develop new drugs and medicines.
b. In 2017, ICMR and the Research Council of Norway (RCN) initiated a joint
call for research in antimicrobial resistance.
c. ICMR also collaborates with the Federal Ministry of Education and Research
(BMBF) in Germany for AMR research.
5. Antibiotic Stewardship Program: ICMR has launched the Antibiotic
Stewardship Program (AMSP) as a pilot project across India to control the misuse
and overuse of antibiotics in hospital wards and ICUs.
6. Regulation of Fixed Dose Combinations (FDCs): The Drug Controller General
of India (DCGI) has banned 40 FDCs that were found to be inappropriate.

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Global Measures:
1. World Antimicrobial Awareness Week (WAAW): Held annually since 2015,
WAAW is a global campaign aimed at raising awareness of AMR and encouraging
best practices among the public, health workers, and policymakers to slow the spread
of drug-resistant infections.
2. The Global Antimicrobial Resistance and Use Surveillance System
(GLASS): Launched by WHO in 2015, GLASS aims to fill knowledge gaps and
inform strategies at all levels. It incorporates data from the surveillance of AMR in
humans, the use of antimicrobial medicines, and AMR in the food chain and
environment.
3. Global Point Prevalence Survey Methodology: Introduced by WHO to
understand antibiotic prescribing patterns in hospitals and track changes in
antibiotic use over time. Several studies in India have utilised this methodology.

Way Forward
1. Public Education Campaigns: Inform the public about AMR, its dangers,
and how to prevent it. This can be done through mass media, community
outreach programs, and educational materials in local languages.
2. Antibiotic Stewardship Programs: Implement programs in hospitals and
clinics to track and optimise antibiotic use, ensuring they are prescribed only
when necessary and for the shortest effective duration.

Y x
3. Regulation of Antibiotic Sales: Implement stricter regulations on the sale
of antibiotics over the counter, requiring prescriptions for all antibiotics.

E R
4. Expand AMR Surveillance: Establish a nationwide AMR surveillance
system to track the prevalence and spread of resistant bacteria in humans,

TI G
animals, and the environment.
5. Develop New Technologies: Explore the potential of new technologies, such
as phage therapy, to address AMR challenges.

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