The recent pandemic has exposed shortcomings in the traditional healthcare system. The lack of trust between the public and the health system is more prominent than ever. Social determinants like economic and social conditions often influence health factors majorly. In fact, numerous studies suggest that social determinants of health account for between 30-55% of health outcomes. It’s not only about having access to services and equipment but also includes action on water and sanitation, environmental health, socioeconomic determinants of health, disease transmission in the area, and health finance.
Health & Equity
India’s health system faces the ongoing challenge of responding to the needs of the most vulnerable sections. Despite progress in improving access to health care, inequalities by socioeconomic status, geography, and gender continue to persist.
A comprehensive and quality primary health care is at the core of realising the goal of Universal health coverage (UHC) for all. Primary care is the foundational base of an efficient, equitable and empathetic health system. Improved water and sanitation, food security, poverty reduction and changes to other structural factors, complemented by a more equitable health system, can ensure more equitable health for more than a billion people.
India’s tribal population often remains out of national discourse and debate regarding health, education, poverty, and other related social and human development indicators. Tribal communities face the “triple burden” of disease. Besides, high rates of malnutrition and communicable diseases (HIV, TB, Leprosy etc.), swift urbanisation, changing lifestyles and the environment have also led to a rise in non-communicable diseases as well (diabetes, cancer, and hypertension).
According to the Tribal Health in India: Bridging the Gap and a Roadmap for the Future —a Tribal Health Council and Directorate for Tribal Health – must be established at both state and union levels, to focus solely on tribal health and to better incorporate tribal health needs into the healthcare system. Successful healthcare delivery models in tribal districts by nonprofits such as SEARCH, Ekjut, and Jan Swasthya Sahayog are grounded in first building rapport and trust with the tribal communities by spending time with them, as well as by enabling and empowering them to participate in the delivery of healthcare services.
Universal Health Care (UHC) is an admirable goal that seeks to extend healthcare access to everyone, based on actual health needs rather than the ability to pay for a service. In India, Out-of-pocket expenditure on health was more than the government’s expenditure on health (48.2% compared to 40.6%), according to the Economic Survey 2022. UHC seeks to expand health coverage, but the depth of coverage will also need to be considered in achieving equity of service accessThe aspirations of UHC include limiting out-of-pocket payments to a level of affordability, and targeted coverage to eliminate costs borne by the poor (WHO, 2013: 6-7).
The WHO advocates that health service provisions should include a broad range of options, such as prevention, treatment, rehabilitation, promotion, and palliative care should be insulated from disasters and pandemics. There is a need to identify key diseases and their nature as well as targeted components of the health system that need to be improved. Negotiating the intersections and complementarities between public and private health provision and the design of a regulatory structure that holds each component of the health system accountable.
Health is highly challenging and complex, requiring the various actors in the multifarious levels and networks of governance to act in the pursuit of better health outcomes for all. People-centric public health and digitally enabled decentralised decision-making can be a step in the right direction. Since independence, many healthcare policies have been formulated incorporating the best recommendations, but they didn’t translate into reality due to a lack of political will. Populist promises of “Universal Health Coverage” can also be not considered a panacea to all health problems. To build a robust healthcare system, time-sensitive and viable infrastructure is the pressing priority.