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Summary

Social Justice Class 04

## BRIEF OVERVIEW OF PREVIOUS CLASS (5:11 PM)

## HEALTH ISSUES (5:13 PM)

- **Concept of Good Health:**
- According to **WHO**, good health is defined as a state of physical, mental and social well-being of individuals rather than mere absence of illness.
- **Manifestation:**
- **Economic good**
- Good health is the source of economic growth and prosperity, saving direct and indirect costs.
- **S****ocial good :**
- It ensures large benefits to a large section of society.
- **For example**, improved learning outcomes absorption of skills, better inter-personal relations, human capital formation etc.
- **Political good:**
- It ensures political participation and the strengthening of democracy.
- It helps in creating an active citizenry
- **Ecological good:**
- It provides for social production consumption and development.

## ISSUES W.R.T. HEALTH CARE SYSTEM (5:25 PM)

- **Lack of infrastructure**:
- **Lack of health workforce:**
- As per the **WHO**, a **1:1000 (Doctor/population) ratio** was **recommended**.
- As per the **Ministry of Health Family Welfare**, this ratio for India is 1:834.
- As per WHO, 53% of medical practitioners do not have the required medical qualification.
- **Privatisation of healthcare:**
- The private sectors see 70% of outpatients and 60% of inpatients.
- **There is a lack of regulation in the Private sector:**
- i. This regulation is currently looked at by the Clinical Establishment Act (2010).
- ii. Health is a **state subject**.
- iii. Because of this out of pocket expenditure is high i.e. 47.1%.
- iv. According to **NITI Aayog Report**,80% of doctors 75% of dispensaries and 60% of hospitals are in urban areas. Thus there is a **rural-urban divide**.
- Weak **primary healthcare** increases the burden on secondary and tertiary care.
- Lack of government spending on **promotive** and **preventive** care.
- The lack of **required infrastructure** in existing **hospitals** makes it difficult to implement government policies for example PM Jan Arogaya Yojana.
- **Absence of medical ethics:**
- i. Provider-induced demand
- ii. Prescribing branded medicine instead of generic medicine. According to **CDSO**, **4.5%** of all generic drugs are identified to be substandard due to a lack of quality testing facilities.
- We are dependent on **imports** concerning API
- **Lack of infrastructure** with respect to **R&D**
- Lack of **trust in Ayush**
- Lack of **integrated health management information system**
- Problems of **self-treatment**
- **Dysfunctional** state of the integrated disease surveillance programme. (The purpose is to monitor disease trends, detect and respond, however, due to lack of manpower resources it has failed to create a robust database).
- According to **IRDA**, **17%** of the population is covered under some kind of insurance.
- **Post COVID** there has been **negative perception** of a medical career.
- Lack of **digitalisation** of healthcare. **For example** - telemedicine, e-pharmacy, eco-clinics.
- Lack of an **adequate number of medical colleges, politicisation and corruption**
- Lack of focus on **emerging health issues**. **For example** - geriatric care, mental health issues, lifestyle diseases, addictions etc.
- **Health-related taboos:** **for example** - sexual and reproductive health, mental disorders, the existence of superstitious practices
- Changing **nature of disease burden**
- Lack of government spending on health
- Attitude towards healthcare

## TIER OF HEALTHCARE SYSTEMS (6:20 PM)

- First primary healthcare, is the backbone of healthcare delivery.
- It is the first point of contact between the community and the healthcare system.
- Its objective is to promote a comprehensive, accessible and relevant healthcare system
- It includes growth monitoring, oral rehydration, breastfeeding, immunisation, food supplements family planning and female health education (mnemonic - GOBI-3F).
- **According to Alma Ata's declaration which specifies the goals of primary healthcare:**
- i. To reduce exclusion
- ii. Organizing the healthcare services around the needs of the people
- iii. Development of appropriate technologies
- iv. Qualitative and Quantitative workforce
- v. Multi-sectoral convergent approach

## CHALLENGES WRT PRIMARY HEALTHCARE (6:26 PM)

- **Lack of government spending**: According to **National Health Policy 2017**, at least **two-thirds** of the health budget should be spent on primary healthcare.
- Increasing in **non-communicable diseases** and a lack of preparedness to address them.  (To address this under Ayushman Bharat health and wellness centres are created which cover both Maternal and Child Health and non-communicable diseases).
- Deficit of **trust** between patient and provider.
- **Top-down approach** i.e. instead of a holistic approach health planning is done according to the convenience of the state.
- Poor **governance** WRT primary healthcare.
- Not understanding the social nature of society.
- **Note:** Kindly refer to the diagram of PHC drawn by the faculty on smartboards.

## SUSTAINABLE GOALS RELATED TO HEALTH (6:41 PM)

- It deals with good health and promoting well-being.
- Reduce MMR
- Fight communicable diseases
- Prevent substance abuse
- Reduce road injury and health
- Promote mental health
- Universal access to reproductive care etc.
- **Government efforts:**
- Pre- Natal- PMSMA
- Peri-Natal - JSY (Janani Suraksha Yojana)
- Post-Natal- JSSK (Janani Shishu Suraksha Karyakaram )
- RMNCH+A (Reproductive, Maternal, Newborn, Child and Adolescent Health) strategy of the government
- Ayushman Bharat scheme
- WRT communicable disease efforts like Swachch Bharat Mission, Jal Jeevan Mission and National AIDS Control Programmes
- WRT affordable healthcare efforts like digitalization, Jan Aushadhi Pariyojana etc
- **Questions:** What are SDG targets with respect to health and to what extent Indian government is prepared to achieve those targets (150 words/ 10 marks)
- **Question:** According to Amartya Sen Primary Healthcare is not robust in India. What according to you are the challenges and how can they be addressed? (150 words/10 marks )
- **Question:** What do you mean by universal health coverage? In the backdrops of its prospects examine the challenges in achieving universal health coverage (150 words /10 marks )
- **Note:** Kindly refer to the handouts for a holistic understanding of universal health coverage.
- ***Ayushman Bharat PM-JAY:***
- *Provide affordable/free healthcare to low-income & middle-income families.*
- ***PMJAY:** Health insurance scheme (₹5 lakhs per family/year) for 10 crore families.*
- ***ABDM:** Develops unified digital health infrastructure.*
- ***PMJAY:** Up to ₹5 lakhs annual coverage for 1350+ illnesses at government & private hospitals.*
- ***ABDM:** Improves efficiency & effectiveness of healthcare services.*
- ***Implementation:***
- *The National Health Agency (NHA) oversees the program.*
- *10,000+ Health & Wellness Centers (HWCs) established nationwide.*

## SECONDARY HEALTHCARE (7:10 PM)

- *Community health centre for 80000 to 1.2 Lakh population.*
- ***Challenges:***
- *Accessibility*
- *Low government spending*
- *Weak governance and accountability*
- *Lack of pending handling capacity*
- *Non-availability of skilled workforce*
- ***Way forwards:***
- *Promoting preventive healthcare*
- *Involvement of SHG & ASHA worker*
- *Increasing insurance coverage*
- *Improving government healthcare spending*

## DIGITALIZATION OF HEALTHCARE INFRASTRUCTURE (7:16 PM)

- ***Prospects:***
- *Address resource gap by efficient utilization of existing man force*
- *Evidence-based planning & decision making*
- *Ensure national portability in providing health services*
- *Availability of services in remote via telemedicine*
- *Enhance the efficiency of healthcare delivery*
- ***Challenges:***
- *Health is a state subject*
- *Underdeveloped infrastructure*
- *Lack of dominant Health IT vendors*
- *Lack of internet accessibility, the problem of data safety*

## MENTAL HEALTHCARE (7:23 PM)

- ***WHO** defines mental health as a state of mental well-being that enables people to cope with the stresses of life, realize their abilities, learn well and work well, and contribute to their community.*
- ***WHO** states mental illness makes up 15% of total disease condition*
- ***Note:*** Kindly refer to the handouts for more better understanding of the Mental Healthcare Act and Covid and Mental Health.

## THE TOPIC FOR NEXT CLASS: EDUCATION