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.
Social 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 (â¹5 lakhs per family/year) for 10 crore families.
ABDM: Develops unified digital health infrastructure.
PMJAY: Up to â¹5 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