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Health Sector in India

Last updated on November 11, 2023 by ClearIAS Team

Health care sector

What is the current Scenario of the Health Care Sector of India? What are the major concerns? How to use India’s huge potential in the health sector to rectify the problems? Read further to know more about  Health Sector in India.

The Constitution considers the “Right to Life” to be essential, and the government is required to protect everyone’s “ Right to Health .”

The healthcare industry in India includes hospitals, medical tourism, health insurance, medical equipment, telemedicine, outsourcing, clinical trials, and medical gadgets.

The public and private sectors make up the two main components of India’s healthcare delivery system.

Table of Contents

The Scenario of the Health Care Sector in India

Let us look at an overview of the current healthcare sector in India

Health Infrastructure

The government, or public healthcare system, concentrates on establishing primary healthcare centres (PHCs) in rural areas while maintaining a small number of secondary and tertiary care facilities in major cities. The majority of secondary, tertiary, and quaternary care facilities are run by the private sector.

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India has 1.3 beds per 1,000 people, 0.5 pharmacists per 1,000 people, and 0.8 physicians per 1,000 people, which are all less than half the global average.

Quality of Health Care Services

India is ranked 145 th out of 180 nations in terms of the accessibility and quality of healthcare, according to the Economic Survey (Global Burden of Disease Study 2016)

To achieve an ideal doctor-to-population ratio of 1:1000 by 2030, India will require an additional 2 million doctors.

Disease Burden

Despite having 17% of the world’s population, India bears a disproportionately large portion of the global disease burden (20%).

India’s public healthcare spending was 2.1% of GDP in 2021–2022, up from 1.8% in 2020–2021, according to the  Economic Survey of 2022 .

Challenges in Health Sector

Although India’s healthcare sector has made significant progress in terms of health indicators, it still has some serious flaws in service delivery due to inadequate healthcare infrastructure.

Inadequate Accessibility

Insufficient access to basic healthcare services to all, due to a shortage of medical professionals, a lack of quality assurance, and insufficient health spending.

Insufficient Funding

One of the major concerns is the administration’s lack of financial resources and insufficient funding for research and development.

India’s government will only spend 2.1% of its GDP on healthcare in 2021–22, compared to 10% for Japan, Canada, and France.

No focus on Preventive Care

Despite being shown to be quite beneficial in alleviating a variety of difficulties for patients in terms of unhappiness and financial losses, preventive care is undervalued in India.

Shortage of Medical Workforce

Doctors, nurses, and other healthcare professionals are in short supply in India. According to a minister’s study presented in Parliament, India is short 600,000 doctors.

Lack of Infrastructure

Private hospitals are expensive, whereas Government hospitals are either inadequate or lacking in basic facilities for the Indian population.

Optimal Insurance

The concept of health insurance is still unclear in India, and the market is underdeveloped.

Policymaking

Policymaking is undeniably important in providing effective and efficient healthcare services. The problem in India is one of supply rather than demand, and policy can help.

Potential in Health Care Sector in India

Despite the challenges, there were opportunities. The Indian healthcare system has a unique opportunity to advance while taking stock of the past and getting ready for the future while keeping the welfare of its people in mind.

Strong Demand

According to Aspire Circle, the Indian healthcare sector is expected to reach $744 billion by 2030, driven by greater access to insurance, better health awareness, lifestyle diseases, and rising income.

Innovative Technologies

As part of the National Digital Health Mission ( NDHM ), the digital Health ID will be introduced, which will save patient data. It would aid in effective policymaking, and private firms would benefit from a competitive advantage in the market introduction of innovative technology.

With the advent of information technology and big data, it would be simple for private players to spend strategically.

Rising Manpower

The abundance of highly qualified medical personnel in India is a competitive advantage. With 4.7 million workers as of 2021, the Indian healthcare industry is one of the country’s largest employers.

From 0.83 million in 2010 to 1.3 million in November 2021, the number of allopathic doctors with recognised medical qualifications (under the I.M.C Act) registered with state medical councils/national medical council

Cost Competent

India’s costs are competitive with those of its countries in Asia and the West. Surgery in India costs roughly a tenth of what it does in the US or Western Europe.

Attractive Opportunities

Two vaccines Bharat Biotech’s Covaxin and Oxford-Covishield, AstraZeneca’s both made by SII were critical in protecting the Indian population from COVID-19.

India has emerged as a hub for R&D activities for international players due to its relatively low cost of clinical research.

With the help of the government and private stakeholders, a climate conducive to start-ups and entrepreneurship can be created in this field.

Hub of Medical Tourism

India is already one of the world’s most popular medical tourism destinations, and this industry has significant potential in the coming years.

The low cost of medical services has resulted in a rise in the country’s medical tourism, attracting patients from across the world.

India possesses all the necessary factors for this industry to grow rapidly, including a sizable population, a strong pharmaceutical and medical supply chain, more than 750 million smartphone users, the third-largest global start-up pool with simple access to Venture Capital funding, and innovative tech entrepreneurs looking to address global healthcare issues.

Measures Required in the Health Sector

These are the following major measures for improving the health sector in India:

  • Strengthening the Infrastructure: Because of India’s large population, there is an urgent need to improve the infrastructure of public hospitals, which are overburdened.
  • Encourage Private Hospitals: The government should support private hospitals because they contribute significantly to the Indian Health sector. The challenges are severe and cannot be addressed solely by the government, the private sector must also participate with Government for the public good.
  • Increased efficiency: More medical personnel must be hired in order to improve the sector’s capabilities and efficiency.
  • Utilization of Technology: Technology must be used to connect the dots in the health system. Medical devices in hospitals and clinics, mobile health apps, wearables, and sensors are just a few examples of technology that should be considered.
  • Improving Mental Health Care Services: Increasing financing for mental health services, educating healthcare professionals on how to effectively treat mental health issues, and lowering the stigma attached to mental illness are all part of improving mental health services.
  • Addressing the Root Causes of Health Disparities: To address the social determinants of health and reduce overall health inequities, the healthcare system should collaborate with other sectors, such as education, housing, and sanitation.
  • Sustainable Health governance: To promote more effective and efficient healthcare services, sustainable health governance may involve implementing better management systems, bolstering healthcare regulatory organisations, and developing independent oversight mechanisms.
  • Make Public Awareness: People should be made aware of the value of early detection and prevention. It would also help them save money on out-of-pocket expenses.
  • One Health Approach: The need for communal health programmes that address a healthy environment, healthy animals, and healthy people is urgent. This is known as the “one health approach,” and it aims to address these connections between human and animal health.

Also read: Medical Device Sector in India

Major Steps Taken by the Government

Despite the fact that health is a state issue, the Central Government assists state governments in providing health services through a variety of primary, secondary, and tertiary care systems.

In the Union Budget 2023-24:

  • Rs. 89,155 crore was allocated to the health sector, an increase of over 13% from the previous budget.
  • Allocated Rs. 6835 crore for establishing 22 new  All India Institute of Medical Sciences (AIIMS).
  • Additionally, the National Health Mission’s budget allocation increased from Rs. 28,974 crore in the preceding years to Rs. 29,085 crore in the current 2023–24 budget.
  • Budgetary support for the National Digital Health Mission increased from the previous year’s Rs. 140 crore to the current Rs. 341 crore.
  • The funds allotted for autonomous bodies were also scaled up, going from Rs. 10,348 crore in the previous budgeted allocation to Rs. 17,322 crore at the moment.

In order to promote medical tourism in the country, the government of India is extending the e-medical visa facility to the citizens of 156 countries.

Prime Minister Mr. Narendra Modi introduced the Ayushman Bharat Digital Mission in September 2021. The endeavour will link the digital health solutions of hospitals across the country. Every citizen will now have access to a digital health ID, and their medical records will be safeguarded online.

In July 2021, the Ministry of Tourism established the ‘National Medical & Wellness Tourism Board’ to promote medical and wellness tourism in India.

In July 2021, the Union Cabinet approved the continuation of the National Ayush Mission , responsible for the development of traditional medicines in India, as a centrally sponsored scheme until 2026.

In July 2021, the Union Cabinet approved the MoU between India and Denmark on cooperation in health and medicine . The agreement will focus on joint initiatives and technology development in the health sector, with the aim of improving public health status of the population of both countries.

India is a land full of opportunities for Health Care and Services. Along with being one of the top places for high-end diagnostic services, the nation has made significant capital investments in advanced diagnostic facilities to serve a larger proportion of the population.

Future demand for healthcare services is anticipated to increase due to factors such as advancing income levels, an ageing population, rising health awareness, and shifting attitudes toward preventative healthcare.

A comprehensive strategy is required to address issues in India’s healthcare industry. This necessitates active collaboration between all stakeholders, including the public, private, and individual sectors.

In 2023, India’s approach to social determinants of health (SDH) could be consolidated and expanded. As a major economic pillar, India must now maintain its existing interest in strategic health policy.

Read:  Climate Resilient Health Systems

Article written by: Aryadevi E S

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Health Care Sector in India

The size of Indian Healthcare sector is expected to reach $ 280 billion by 2020 as per some reports.  Healthcare industry in India comprises hospitals, medical tourism, health insurance, medical equipment, telemedicine, outsourcing, clinical trials, medical devices.

  • The multiple reasons for growth are increased diseases due to lifestyles, rising income, greater health awareness, improved access to insurance.
  • As per 2016 report India had reduced the Maternal Mortality Ratio (MMR) by around 26% since 2013.
  • The hospital industry is expected to reach approximately $ 132 billion by 2022.
  • 74% of expenditure in the healthcare sector comes from Private sector.
  • Medical tourism segment in India is growing at the rate of 18% and it is expected to reach $ 9 billion by 2020.

Aspirants would find this topic very helpful while preparing for the IAS Exam .

Central Government Schemes – Healthcare Sector in India

Health is a state subject, the Central Government supplements the efforts of the State Governments in delivery of health services through various schemes for primary, secondary, and tertiary care.

  • By 2025, the Government of India is planning to increase the expenditure on Health care to 2.5% of the GDP.
  • In the Union Budget 2020-21, the Ministry of Health and Family Welfare was allocated a budget of more than Rs 65,000 crores. 
  • In Budget 2020-21, Government of India has approved the extension of National Health Mission with an allocated budget of around Rs 34,000 crores.
  • The National Nutrition Mission has set an objective of reducing the under nutrition, problems of stunting by 2%
  • The Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (PMJAY) – This is the largest health care program funded by the Government. 
  • In the Union Budget 2020-21, PMJAY was allocated a budget of more than Rs 6400 crores.
  • As of Nov 2019, more than 63 lakh people have received free treatment under Ayushman Bharat – PMJAY.
  • In the Union Budget 2020-21, Government of India allocated Rs 3,000 crores for Pradhan Mantri Swasthya Surakhsa Yojana (PMSSY).

Similar Articles which an IAS Aspirant should read to holistically approach the topic,  Health Care Sector in India:

Ayushman Bharat

  • It is a centrally sponsored scheme for underprivileged families. It can potentially cover around 50 crore beneficiaries.
  • It provides coverage of up to Rs 5 lakhs per family per year for secondary and tertiary care hospitalization.
  • Ayushman Bharat National Health Protection Mission Council (AB-NHPMC) will be established at the apex stage,chaired by the Ministry of Health and Family Welfare.
  • The benefits of the scheme are portable throughout the country and a beneficiary covered by the scheme will be allowed to receive cashless benefits from any public/private hospital throughout the country.

Candidates can read in detail on   Ayushman Bharat  on the linked page.

Health Care Sector in India – UPSC Notes:- Download PDF Here

The above details would help candidates prepare for UPSC 2023 .

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Health Sector in India – Holistic Study Part 1

civils360

  • January 23, 2020

Health Sector in India – Holistic Study

Preventive Health Care

  • Poverty, Malnutrition, Hunger, Substance Abuses, Sanitation, Clean Drinking Water, Food Safety, Immunization.

Curative Health Care

Communicable and Non-communicable Diseases

Issues in India’s Health Sector

  • Accessibility :
  • Regional disparity in the provision of healthcare services – Lack of PHCs and CHCs in certain rural areas of the country. Hence rural population are denied access to primary healthcare which aggravates their health problems and eventually become a burden on tertiary health sector which is not equipped to deal with the high inflow of patients.
  • Inadequate doctor to patient ratio: According to the National Health Profile , India has a million doctors to treat its 1.3 billion Doctors largely render services in urban areas and hence rural population are left vulnerable
  • Lack of Public Expenditure: India is currently spending only 1.2% of its GDP on the health sector. This reflects the low level of political commitment for ensuring health care and how it has never been an electoral issue
  • Prices of Drugs: Even when medical services and expertise is available and affordable, an average citizen in India spends a large amount of money on drugs prescribed. The nexus between doctors and pharmaceutical companies has often exploited the patients to earn large profits
  • No Health Insurance Policy and Minimal Coverage: The citizens spent highest on medical services from out of their pocket
  • Infrastructure: Government hospitals are often ill-equipped to provide specialized care and devices and medical infrastructure are old and need of maintenance and repair. There is also an issue of lack of adequate beds in public hospitals
  • Technical Expertise: The NITI Aayog in its Action Agenda points out that India faces a huge challenge in the number, distribution, skill and quality of health care expertise.
  • Inefficiency in Regulation and Monitoring Mechanism: Medical Council of India consumed with Nepotism and Corruption means healthcare institutions are neither adequately monitored nor regulated in their management or administration giving them a free hand at providing lacklustre services to citizens
Read Also Social Justice in Education Sector
  • Fight with Communicable Diseases: NITI Aayog reports India lost 33% of its DALYs owing to the communicable diseases
  • Diverse requirements from the health sector that needs to cater to both CMNNDs as well as NCDs
  • The burden of Expenditure: NCD treatment is more expensive as compared to CMNND disease thus putting further pressure on the government’s economic resources
  • NITI Aayog reports a rising morbidity and mortality cost attributed to NCDs
  • Threat of New diseases

Prospective Solutions

  • Correct regional disparity in provision of health care Services : Set up PHCs and CHCs in unserved and underserved areas. Recruit greater number of ASHA workers and ensure the smooth functioning so that they can act as bridge between villagers and access to healthcare services.
  • Incentivize Service in rural areas: Doctors and nurses should be financially incentivized to serve in rural and remote areas to ensure that people in these areas are not left behind for access to quality medical care
  • Rapidly Increase Public Spending: As per NHP, public health expenditure needs to be doubled to 2.4% of GDP from current 1.2%. Even such an increase would pale in comparison to what other countries are spending on their healthcare sector
  • Gen Oushadi Shops: To sell affordable medicines in the form of generic drugs to citizens
  • Introduce a health insurance policy: The government through the NHPS is aiming to provide such an insurance coverage to 10 crore beneficiaries.
  • Strategic Engagement and System Strengthening with Private sector Partnership: Enhance technical, infrastructure and specialized healthcare service quality by forming partnerships with private sector entities
  • Raising public spending
  • Overhaul Monitoring and Regulation Mechanism : Introduce exit eligibility test for doctors, incentivize working in rural areas and replacing MCI with National Medical Commission
  • Holistic development of public health addressing all social determinants including nutrition, sanitation and drinking water. The focus on entirety shall be a far cry from the sole focus on provisioning of health care
  • Preventive> Cure: The public health system through the promotion of healthy life styles, prevention of injuries and detection and control of infectious diseases can achieve preventive cure. The state must then reprioritize its goals to transition from curative to preventive
  • Role of the Government: The NITI Aayog advices the government to play a stewardship role in setting and enforcing rules to guide the health system. A data driven decentralized model can help in bettering health outcomes

National Health Policy, 2017

First National Health policy in 15 years seeks to ensure universal access to affordable quality healthcare services to all citizens in the country.

  • Comprehensive Healthcare package including palliative, rehabilitative and geriatric healthcare
  • Providing digital health card for access to health services from all over India
  • Gen Oushadi Shops to enhance access to affordable generic drugs
  • Integration of traditional medicines into mainstream health care services
  • Co-location of AYUSH with western medical facilities in public hospitals
  • Production of Active Pharmaceutical ingredients
  • Enables to reduce import of drugs and creation of customized indigenous drugs
  • Eases affordability for drugs in market
  • Establishment of National Healthcare Standards Organization
  • Maintain Quality of healthcare
  • Electronic Database for access to patient records for all doctors from anywhere in India
  • Tele-medicine yielding dual benefits of employment generation and better and equitable access to medical services in far flung regions
  • Establishment of National Digital Health Authority
  • Entering into sustainable models of partnerships with private sector entities, both for-profit and not-for profit to improve quality of healthcare services rendered in terms of infrastructure and technical expertise
  • Objective to improve access to quality screening, diagnosis, treatment services for cardiovascular, pulmonary diseases and cancer in district hospital through PPP
  • Increase Public expenditure to 2.5% of GDP

Primary healthcare

  • Coverage: There exists a regional disparity in coverage of PHC network in India. While the average area per sq.km covered by a PHC in Goa is less than 2 sq.km, it is more than 160 in Rajasthan
  • Human Resource Deficiency: According to Ministry of Health and Family Welfare’s manpower statistics, there are more than 8000 doctor vacancies. Similarly, the female/ANM workforce is short by more than 1000.
  • Highest out of pocket Expenditure: Medicines are costly and often not available within PHCs which forces patients to go outside and buy medicines at higher cost
  • Infrastructural Gaps: The Rural Health Survey of 2016 notes that there is a shortfall of 20 to 30% of buildings with regard to PHCs and CHCs. According to the MoHFW, only less than 2% of PHCs meet the Indian Public Health Standards (IPHS) with regard to electricity, sanitation, water supply, diagnostic facility and distribution of drugs.
  • Lack of Awareness: India’s villages are pulled back by patriarchal, caste and religious ideologies that often neglect healthcare systems. This has impacted the demand of healthcare service
  • No specialized Care: PHCs are generalist in their service and does not cater to geriatric or palliative healthcare and emergency services. Majority of the mental health centres are urban concentrated.
Read Also Social Justice- Vulnerable Sections

Way Forward

  • Public Expenditure and Private sector participation: The gross infrastructural gaps in PHCs and CHCs can be corrected by increasing public expenditure and exploring systemic strengthening with private sector engagement . Viability gap funding for PHCs in remote areas might be explored
  • Incentivize Doctors: Doctors can be financially incentivized to serve in rural and remote regions of the country. Medical education system shall be reformed to increase the expertise of doctors via a licentiate exam
  • Greater recruitment of ASHA workers: A decentralised multi-sectoral health care can only be achieved through leveraging ASHA workers at grass root level to spread awareness among people regarding benefits of primary healthcare and immunization
  • Decentralized Data Drive Health Delivery System: Better convergence and targeting can be achieved for the work undertaken by AAA workers (ASHA, Anganwadi and ANM) through the usage of micro-data to understand trends and prioritize individuals or households in need of heath care
  • Mental Health centres in Rural Areas: In the light of farmer suicides and the livelihood crisis that plagues the rural areas, there is a pertinent need to provide mental health care in rural areas. A network of counsellors, psychologists and psychiatrists shall be instituted to deal with the mental problems of the rural population.

Government Interventions

  • Greatly enhance coverage and ease accessibility to PHC services for early diagnosis and treatment
  • Strengthening hospital infrastructure and capacity .
  • Correct the expertise balance as doctors and nurses as they would be able to specialize without relocation .
  • Health and Wellness Centres: The government has also outlined in the budget an initiative to establish 1.5 Lakh health and wellness centres across the country to enhance accessibility of PHC to needy citizens
  • National Mobile Medical Units: To provide doorstep health service delivery
  • Skill for live Save a Life: Recruitment of ASHA workers to provide decentralized health service and awareness
  • NHM Free drugs and diagnostics services to correct out of pocket expenses

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Recently ,it has been noticed that Healthcare in India is ailing.

Health System in India 

  • Healthcare has become one of India’s largest sectors, both in terms of revenue and employment. 
  • The Indian healthcare sector is growing at a brisk pace due to its strengthening coverage, services and increasing expenditure by public as well private players.
  • The government, i.e. public healthcare system, comprises limited secondary and tertiary care institutions in key cities and focuses on providing basic healthcare facilities in the form of primary healthcare centres (PHCs) in rural areas. 
  • The private sector provides a majority of secondary, tertiary, and quaternary care institutions with major concentration in metros and tier-I and tier-II cities.

Potential  

essay on health sector in india upsc 2020

Government Initiatives

  • In the Union Budget 2022-23: Rs. 86,200.65 crore (US$ 11.28 billion) was allocated to the Ministry of Health and Family Welfare (MoHFW).
  • Pradhan Mantri Swasthya Suraksha Yojana (PMSSY) was allocated Rs. 10,000 crore (US$ 1.31 billion)Human Resources for Health and Medical Education was allotted Rs. 7,500 crore (US$ 982.91 million).
  • The National Health Mission was allotted Rs. 37,000 crore (US$ 4.84 billion).
  • Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) was allotted Rs. 6,412 crore (US$ 840.32 million).
  • In November 2021, the Government of India, the Government of Meghalaya and the World Bank signed a US$ 40-million health project for the state of Meghalaya. 
  • The mission will connect the digital health solutions of hospitals across the country with each other. Under this, every citizen will now get a digital health ID and their health record will be digitally protected.
  •  The Ministry of Health has issued guidelines to states to establish a public health cadre.

Issues /Challenges 

  • India’s healthcare system has been battling various issues, including the low number of institutions and less-than-adequate human resources .
  • India has been struggling with deficient infrastructure i n the form of lack of well-equipped medical institutes for quite a while now. 
  • Shortage of efficient and trained manpower and The situation remains worrisome in rural areas.
  • Even prior to the outbreak of the Covid-19 pandemic, healthcare facilities had been feeling the strain due to unmanageable patient-load. 
  • High out-of-pocket expenditure remains a stress factor.

Conclusion and Way Forward 

  • There is an urgency to focus on all the three levels of p rimary, secondary and tertiary healthcare , it is imperative that the government look towards improving primary health care as a public good.
  • The lesson emerging most unequivocally from the pandemic experience is that if India does not want a repeat of the immeasurable suffering and the social and economic loss, we need to make public health a central focus. 
  • There is also a need to declutter policy dialogue and provide clarity to the nomenclatures. 
  • India needs to move beyond the doctor-led system and paramedicalise several functions.

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Role of modern technologies in india’s affordable housing, panchayats as self-governing institutions, rise of ‘intelligence diplomacy’ in a time of security challenges, daily current affairs 22-02-2024.

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essay on health sector in india upsc 2020

  •  07 Jul,2023

The " Right to Life " is considered essential by the Constitution, and the government is required to protect everyone's " right to health ." The federal system of India, as well as the responsibilities and funding splits between the Centre and the states, have affected the  health sector  to a large extent. The states are in charge of planning and delivering health care to their citizens. Healthcare has become more focused on innovation and technology over the past two years and  80% of healthcare systems are aiming to increase their investment in digital healthcare tools in the coming five years .

According to some estimations, the Indian healthcare sector will be worth $774 billion by 2030. Hospitals, medical tourism, health insurance, medical equipment, telemedicine, outsourcing, clinical trials, and medical gadgets are all part of India's healthcare industry.

Problems pertaining to the Healthcare sector

Insufficient Medical personnel :

  • There is a massive shortage of medical staff, infrastructure and last-mile connectivity in rural areas. Ex.   Doctor: Population 1:1800   and 78% of doctors cater to urban India (population of 30%).
  • Massive shortages in the supply of services (human resources, hospitals and diagnostic centres in the private/public sector) are made worse by grossly inequitable availability between and within States.
  • For example, even a well-placed State such as Tamil Nadu has an over 30% shortage of medical and non-medical professionals in government facilities.
  • 61% of PHCs have just one doctor, while nearly 7% are functioning without any
  • 33% of PHCs do not have a lab technician, and 20% don’t have a pharmacist.
  • In states like Odisha, more than 3,000 government posts for doctors or about 50% of all government medical doctor posts are lying vacant.

Health budget :

  • India’s expenditure on the  health  sector has risen meagerly from 1.2 per cent of the GDP in 2013-14 to  4 per cent in 2017-18 . The National Health Policy 2017 had aimed for this to be  2.5% of GDP .
  • The health budget has neither increased in real terms nor is there any policy to strengthen the public/private sector in deficit areas. While the  Ayushmaan Bharat provides portability ,  one must not forget that it will take time for hospitals to be established in deficit areas.
  • This in turn could cause patients to gravitate toward the southern States that have a comparatively better health infrastructure than the rest of India.

Infrastructure constraints :

  • There are doubts about the capacity of India’s infrastructure to take on the additional load of patients during  pandemics like Covid-19  as seen recently.
  • There is a growing medical tourism (foreign tourists/patients) as a policy being promoted by the government, and also domestic patients, both insured and uninsured.

Crumbling public health infrastructure :

  • Given the country’s crumbling public healthcare infrastructure, most patients are forced to go to private clinics and hospitals.
  • There is a shortage of  PHCs (22%)  and  sub-health centres (20%) ,  while  only 7% of sub-health centres and 12% of primary health centres meet Indian Public Health Standards (IPHS) norms .
  • In the northern States, there are hardly any sub-centres and primary health centres are practically non-existent. First-mile connectivity to a primary healthcare centre is broken.  For eg, in Uttar Pradesh, there is one PHC for every 28 villages .

The strong role of Private players :

  • Approximately 70 per cent of the healthcare services in India are provided by private players. If private healthcare crumbles due to economic constraints or other factors, India’s entire healthcare system can crumble.
  • Over 70 per cent of the total healthcare expenditure  is accounted for by the private sector.
  • However, Private hospitals don’t have adequate presence in Tier-2 and Tier-3 cities and there is a trend towards super specialisation in Tier-1 cities.
  • lack of transparency and unethical practices  in the private sector.
  • The lack of a level playing field between the public and private hospitals  has been a major concern as public hospitals would continue receiving budgetary support. This would  dissuade the private players from actively participating in the Governmental scheme .

High Out of pocket expenditure :

  • According to  the latest National Health Accounts (NHA) estimates  released in March 2021, patients bear a big chunk of health expenses, as high as 61 per cent of the total health expenditure, by themselves.
  • Even the poor are forced to opt for private healthcare, and, hence, pay from their own pockets. As a result, an estimated 63 million people fall into poverty due to health expenditures, annually.
  • Inequities in the health sector exist due to many factors like geography, socio-economic status and income groups among others. Compared with countries like Sri Lanka, Thailand and China, which started at almost similar levels, India lags behind its peers on healthcare outcomes.

Poor insurance penetration :

  • India has one of the lowest per capita healthcare expenditures in the world. Government contribution to insurance stands at roughly 32 per cent, as opposed to 83.5 per cent in the UK.
  • The high out-of-pocket expenses in India stem from the fact that 76 per cent of Indians do not have health insurance.

Fake doctors :

  • Rural medical practitioners (RMPs) ,  who provide 80% of outpatient care, have  no formal qualifications for it .
  • People fall prey to  quacks , often leading to grave disabilities and loss of life.

Numerous Schemes and their limitations :

  • The Government has launched many policies and health programmes but success has been partial at best.
  • The  National Health Policy(NHP) 2002  proposed to increase Government spending on health by two to three per cent of the gross domestic product (GDP) by 2010 which has not happened yet.
  • Now, the  National Health Policy 2017 , has proposed to take it to 2.5 per cent of the GDP by 2025.
  • The overall situation with the  National Health Mission , India’s flagship programme  in primary health care, continues to be dismal.
  • The NHM’s share in the health budget fell from 73% in 2006 to 50% in 2019 in the absence of uniform and substantial increases in health spending by States.

Healthcare without a holistic approach :

  • There are a lot of determinants for better health like improved drinking water supply and sanitation; better nutritional outcomes, health and education for women and girls; improved air quality and safer roads which are  outside   the  purview of the Health Ministry .

Issues in particular with Urban healthcare

  • Rural-urban disparity :  Until recently ,  Union government mostly focused on rural healthcare. Ex: expenditure on urban areas was  ₹ 850 crore in 2019-20, compared to nearly   ₹30,000 crore for rural.
  • Lack of government primary and preventive health infrastructure :  Against a norm-based target of 9,072 urban primary health centres (UPHCs), only 5,190 are operational.
  • Most states do not have  urban sub-centres (SCs ) , people’s first point of access to healthcare services. There are only 3,000 urban SCs compared to over 150,000 in rural areas.
  • Urban areas also suffer from ‘ over-hospitalization ’  of basic care, ideally done in clinics.
  • Lack of devolution of functions by state government and  inadequate role clarity  among various health-related agencies
  • The poor financial condition of ULBs  and low priority accorded to health.

Issues in particular with Rural healthcare

  • Only  11% of sub-centres, 13% of Primary Health Centres (PHCs) and 16% of Community Health Centres (CHCs)  in rural India meet the  Indian Public Health Standards (IPHS) .
  • Only one allopathic doctor is available for every 10,000 people and one state-run hospital is available for 90,000 people.
  • Innocent and illiterate patients or their relatives are exploited, and they are allowed to know their rights.
  • Most of the centres are run by  unskilled or semi-skilled paramedics and doctor  in the rural setup is rarely available.
  • Patients when in emergency sent to the tertiary care hospital where they get more confused and get easily cheated by a group of health workers and middlemen.
  • Non-availability of basic drugs  is a persistent problem in India’s rural healthcare.
  • In many rural hospitals, the number of nurses is much less than required.

Central Government Schemes for Healthcare Sector in India

Health is a state subject , the Central Government supplements the efforts of the State Governments in the delivery of health services through various schemes for primary, secondary, and tertiary care.

  • By 2025, the Government of India is planning to increase the expenditure on Health care to 2.5% of the GDP.
  • In the Union Budget 2020-21, the Ministry of Health and Family Welfare was allocated a budget of more than Rs 65,000 crores.
  • In Budget 2020-21, the Government of India has approved the extension of the National Health Mission with an allocated budget of around Rs 34,000 crores.
  • Under the  National Health Mission (NHM) ,  financial support is provided in the following areas: ASHAs workers, ambulances, mobile medical units (MMUs), drugs and equipment, support for Reproductive, Maternal, New-born, Child & Adolescent Health (RMNCH+A).
  • The  National Nutrition Mission  has set an objective of reducing undernutrition, and problems of stunting by 2%
  • The  Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (PMJAY)  – This is the largest healthcare program funded by the Government.
  • In the Union Budget 2020-21, PMJAY was allocated a budget of more than Rs 6400 crores.
  • As of Nov 2019, more than 63 lakh people have received free treatment under Ayushman Bharat – PMJAY.
  • In the Union Budget 2020-21, the Government of India allocated Rs 3,000 crores for  Pradhan Mantri Swasthya Suraksha Yojana (PMSSY) .

The potential of the Indian Health Sector?

  • India's competitive advantage lies in its   large pool of well-trained medical professionals . India is also cost-competitive compared to its peers in Asia and Western countries. The  cost of surgery in India is about one-tenth  of that in the US or Western Europe.
  • India has all  the essential ingredients for the exponential growth  in this sector, including   a large population, a robust pharma and medical supply chain, 750 million plus smartphone  users,  3 rd  largest start-up pool   globally with easy access to  VC (Venture Capital Fund) funding and innovative tech entrepreneurs  looking to solve global healthcare problems.
  • India will have about  50 clusters for faster clinical testing of medical devices to boost product development and innovation .
  • The sector will be driven by life expectancy, shift in disease burden, changes in preferences, growing middle class, increase in health insurance, medical support, infrastructure development and policy support and incentives.
  • As of 2021, the Indian healthcare sector is  one of India’s largest employers as it employs a total of 4.7 million people .  The sector has generated 2.7 million additional jobs in India between 2017-22 -- over 500,000 new jobs per year

Opportunities in Health Care Sector

  • By 2030, the Indian healthcare sector is estimated to reach US$ 744 billion according to a report by Aspire Circle.
  • Data Analytics : The  National Digital Health Mission (NDHM)  will bring with it the  digital Health ID , which will save patient data. It would  aid in effective policymaking, and private firms  would gain an advantage in the market introduction of innovative technology.
  • Investing privately : It would be simple for private players to spend strategically with the  arrival of information technology and big data . As we all know, the Indian healthcare sector is in urgent need of workers, and there is room for thousands of people.
  • Start-ups :  A  climate conducive to start-ups and entrepreneurship  can be formed in this field with the support of the government and private stakeholders.
  • Medical Tourism : India is already one of the most popular  medical tourism  destinations in the world, and this industry can be effectively tapped in the next years.

Measures Required in the Health Sector

  • Improving infrastructure : There is an urgent need to improve the infrastructure of public hospitals, which are overburdened as a result of India's large population.
  • Focus on private hospitals : The government should encourage private hospitals because they make a significant contribution. Because the difficulties are severe and cannot be tackled just by the government, the private sector must also engage.
  • Increased efficiency : To improve the sector's capabilities and efficiency, more medical personnel must be hired.
  • Utilization of technology : In order to connect the dots in the health system, technology must be used. Medical gadgets in hospitals and clinics, mobile health apps, wearables, and sensors  are only a few examples of technology that should be included in this area.
  • Awareness :  People should be made aware of the importance of early detection and prevention. It would also assist them in  reducing their out-of-pocket expenses .

There is an   urgent need to improve the infrastructure of public hospitals ,  which are overburdened as a result of India's large population. The government  should encourage private hospitals  because they make a significant contribution. Because the difficulties are severe and cannot be tackled just by the government, the  private sector must also engage . To improve the sector's capabilities and efficiency,   more medical personnel must be inducted . In order to connect the dots in the health system, technology must be used. Medical gadgets in hospitals and clinics, mobile health apps, wearables, and sensors are only a few examples of technology that should be included in this area.

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Issues related to Health Sector in India | UPSC Notes

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The World Health Organisation says that health is a state of full physical, mental, and social well-being, not just the lack of illness or disease.

Hospitals, medical devices, clinical trials, outsourcing, telemedicine, medical tourism, health insurance, and medical equipment are all part of the healthcare business.

India’s health care system is made up of both state and private health service providers at the moment. Networks of basic, secondary, and tertiary health care facilities, which are mostly run by State Governments, offer free or very cheap medical care. There is also a large private health care industry, which includes everything from individual doctors and their clinics to general hospitals and super specialty hospitals.

Table of Contents

  • 1 Problems pertaining to Healthcare sector in India
  • 2 Issues in particular with Urban healthcare
  • 3 Issues in particular with Rural healthcare
  • 4 Schemes from India’s central government for the health care sector
  • 5 India needs to take steps in the health field
  • 6 The next step

Problems pertaining to Healthcare sector in India

Not enough medical staff: • There is a huge lack of medical staff, infrastructure, and connections to the last mile in rural places. g.: There are 1 doctor for every 1800 people, and 78% of them work in cities, where 30% of the people live.

• There are huge gaps in the supply of services (like people, hospitals, and diagnostic units in the private and public sectors), which are made worse by the fact that they aren’t available in the same way in all States or even in some of them.

• For example, even in a well-placed state like Tamil Nadu, government facilities are over 30% short of medical and non-medical workers.

• 61% of PHCs only have one doctor, and almost 7% don’t have any.

• Only 33% of PHCs have lab technicians, and only 20% have chemists.

• In places like Odisha, there are more than 3,000 empty government doctor jobs, which is about half of all government doctor jobs.

• India’s spending on health care has gone from 1.2% of GDP in 2013-14 to 4.0% of GDP in 2017-18. This is a small increase. This was supposed to be 2.5% of GDP, according to the National Health Policy for 2017.

• The health budget hasn’t grown in real terms, and there isn’t a plan to make the public and private sectors stronger in places where they are weak. Even though Ayushman Bharat makes health care portable, it is important to remember that it will take time for hospitals to be built in areas that need them. This could cause people to move to the southern states, which have better health care facilities than the rest of India.

Infrastructure problems: • There are questions about whether India’s infrastructure can handle the extra cases during pandemics like Covid-19.

• As a strategy, the government is trying to get more medical tourists and patients from other countries, as well as more insured and uninsured patients from their own country.

The country’s public health care system is falling apart, so most people have to go to private centres and hospitals.

• There aren’t enough PHCs (22%) and sub-health centres (20%), and only 12% of primary health centres and 7% of sub-health centres meet Indian Public Health Standards (IPHS).

• There aren’t many sub-centers or basic health centres in the northern states. The connection to a basic healthcare centre in the first mile is broken. For example, there is one PHC for every 28 towns in Uttar Pradesh.

• More than 70% of all money spent on health care comes from the business sector.

• However, there aren’t enough private hospitals in Tier-2 and Tier-3 cities, and there’s a trend in Tier-1 places towards superspecialization.

• A lack of openness and bad behaviour in the private industry.

• The fact that public and private hospitals don’t have the same rules has been a big worry, especially since public hospitals would still get money from the government. This would make private players less likely to take part in a government plan.

High Out-of-pocket costs: • According to the latest National Health Accounts (NHA) figures, which came out in March 2021, patients pay up to 61% of the total cost of health care out of their own pockets.

• Even poor people have to choose private health care and pay for it out of their own money. Because of this, about 63 million people fall into poverty every year because of health costs.

• There are differences in health care because of many things, including geography, socioeconomic standing, and income groups, among others. India’s health care results aren’t as good as those of countries like Sri Lanka, Thailand, and China, which all started out at about the same level.

Not enough people have insurance:

• India has one of the world’s lowest health care costs per person. In the UK, the government pays about 83.5 percent of the cost of insurance. In the US, the government pays about 32 percent.

• The fact that 76% of Indians don’t have health insurance means that they have to pay a lot out of pocket for medical care.

Fake doctors: • Rural medical practitioners (RMPs), who provide 80% of outpatient care, have no official training for it.

• People fall for quacks, which can cause serious injuries or even death.

Numerous Schemes and Their Limits: • The government has started a lot of policies and health schemes, but only some of them have worked.

• The National Health Policy (NHP) of 2002 called for the government to spend 2%–3% of the gross domestic product (GDP) more on health care by 2010. This has not happened yet.

• Now, the 2017 National Health Policy wants to bring it up to 2.5% of the GDP by 2025.

• The National Health Mission, India’s flagship plan for primary health care, is still in a bad place overall.

• The NHM’s part of the health budget dropped from 73% in 2006 to 50% in 2019 because States didn’t raise their health spending in the same way and by the same amount.

Without a whole-person approach, healthcare:

• There are a lot of things that affect health that aren’t under the Health Ministry’s control, like better drinking water and sanitation, better diet, health, and education for women and girls, and safer roads and cleaner air.

Issues in particular with Urban healthcare

• Rural-urban disparity: Up until recently, the Union government focused mostly on health care in rural areas. Example: In 2019-20, 850 crore was spent on urban areas, while nearly 30,000 crore was spent on rural areas.

• Lack of basic and preventive health infrastructure on the part of the government: Only 5,190 of the norm-based goal of 9,072 urban primary health centres (UPHCs) are open.

• Basic care that should be done in clinics is also “over-hospitalized” in cities.

• The state government doesn’t give out enough jobs, and the roles of the different health-related bodies aren’t clear enough.

• ULBs don’t have enough money, and health isn’t a high concern.

Issues in particular with Rural healthcare

• The Indian Public Health Standards (IPHS) are met by only 11% of sub-centers, 13% of Primary Health Centres (PHCs), and 16% of Community Health Centres (CHCs) in rural India.

• There is only one allopathic doctor for every 10,000 people, and there is only one state-run hospital for every 90,000 people.

• Patients or their family members who are innocent and can’t read or write are taken advantage of, and they aren’t told what their rights are.

• Most of the centres are run by paramedics who don’t have a lot of training or don’t have a lot of training at all. In rural areas, it’s hard to find a doctor.

• In an emergency, patients are sent to a tertiary care hospital, where a group of health workers and brokers can easily take advantage of them.

• One problem with India’s rural health care is that simple drugs aren’t always available.

• In many country hospitals, there aren’t as many nurses as they need to be.

Schemes from India’s central government for the health care sector

Health is a state responsibility. The Central Government helps the State Governments provide basic, secondary, and tertiary health care through a number of programmes.

• The Indian government wants to spend 2.5% of the country’s GDP on health care by 2025.

• The Union Budget 2020-21 gave more than Rs 65,000 crores to the Ministry of Health and Family Welfare.

• In fund 2020-21, the Indian government gave the National Health Mission a fund of around Rs 34,000 crores to keep going.

• The National Health Mission (NHM) helps pay for ASHA workers, ambulances, mobile medical units (MMUs), drugs and tools, and support for reproductive, maternal, newborn, child, and adolescent health (RMNCH+A).

• The goal of the National Nutrition Mission is to reduce undernutrition and stunting by 2%.

• The Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (PMJAY) is the largest government-funded health care programme.

• PMJAY was given a fund of more than Rs 6400 crores in the Union fund for 2020-21.

• As of November 2019, more than 63 lakh people have been treated for free through the Ayushman Bharat – PMJAY programme.

• In the Union Budget for 2020-21, the Indian government gave Rs 3,000 billion to the Pradhan Mantri Swasthya Suraksha Yojana (PMSSY) programme.

India needs to take steps in the health field

• Public spending needs to go up right away to 2.5% of GDP, even though that’s less than the world average of 5.4%.

• A worry-free and all-encompassing health care system for everyone depends on how well health and wellness centres work. This is because they will help reduce the greater load of out-of-pocket health care costs.

• We need to stop the current trend of inconsistent and insufficient growth in health spending and put a lot of money into public health over the next ten years.

• A National Health Regulatory and Development Framework needs to be made to improve the quality, performance, fairness, effectiveness, and accountability of healthcare service across the country. For example, health practitioners need to be registered.

• Make more public-private partnerships to get health care to the last mile.

• The government’s National Innovation Council, whose job it is to give healthcare experts, stakeholders, and other key players a place to work together, should promote a culture of innovation in India and help make policy on innovations that will focus on an Indian model for growth that benefits everyone.

• India should work towards Universal Health Coverage like other growing countries, like Thailand. UHC is made up of three parts: There is support for people, diseases, and costs.

• Using the benefits of IT, like e-health and m-health programmes based on computers and mobile phones, to improve the quality of health care services. From process automation to diagnostics to low-cost innovations, start-ups are putting money into the healthcare industry. To make health care available and affordable, there should be policy and regulation support.

The next step

• To solve problems in the healthcare business, India needs to look at the whole picture.

• This means that the public, private, and individual groups must all work together actively.

• We need to stop spending on health in a way that is inconsistent and not enough, and instead put a lot of money and time into public health over the next ten years.

Increase the number of generic drugs and Jan Aushadi Kendras to make medicines more affordable and reduce the major part of Out of Pocket Expenditure. The government’s National Innovation Council, which is supposed to provide a platform for collaboration between healthcare domain experts, stakeholders, and key participants, should encourage a culture of innovation in India and help develop policy on innovations that will focus on an Indian model for inclusive growth. UHC is made up of three parts: There is support for people, diseases, and costs.

• Using AYUSH services for care that isn’t life-threatening, as was shown during the pandemic, can be a key way to boost the capacity of allopathic services.

• To deal with the double disease burden, we need a more dynamic and proactive method.

• If everyone has access to health care, the country will be fit and healthy, which will help the country take advantage of the generational dividend.

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India’s Health Sector

  • March 6, 2023

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Context : Recently the Government of India and World Bank signed two complimentary loans worth $1 billion to support and enhance India’s healthcare infrastructure.

About India’s healthcare sector at glance:

essay on health sector in india upsc 2020

  • In the Economic Survey of 2022 , India’s public expenditure on healthcare stood at 1% of GDP in 2021-22 against 1.8% in 2020-21 and 1.3% in 2019-20.
  • India had 7 physicians per 1,00,000 people in 2017 (in contrast to 98 in Pakistan, 100 in Sri Lanka and 241 in Japan).
  • 53 beds per 1,00,000 people (in contrast to 63 in Pakistan, 79.5 in Bangladesh, 415 in Sri Lanka and 1,298 in Japan).
  • 7 nurses and midwives per 1,00,000 people (in contrast to 220 in Sri Lanka, 40 in Bangladesh, 70 in Pakistan, and 1,220 in Japan).
  • India has among the highest out-of-pocket (OOP) expenditures of all countries in the world- 62% of the total health expenditure in India is OOP.
  • According to the World Health Organization (WHO), India ranks 184 out of 191 countries in health spending.
  • The US spends over 16% of its total GDP on healthcare , while Japan, Canada, Germany etc. spend over 10% of their GDP on healthcare.

Health Index for states developed by Niti Aayog:

essay on health sector in india upsc 2020

  • The Health Index for States developed by Niti Aayog in consultation with the health ministry and the World Bank has rankings for large states, smaller states and Union territories.
  • It is based on 23 health parameters ranging from mortality rate and sex ratio to functioning cardiac care units.
  • In 2019, Kerala was the top performer followed by Andhra Pradesh and Maharashtra.
  • The index results indicated that states even with a lower economic output are performing better on health and well-being.

Challenges associated with India’s healthcare sector:

  • Low Budget Spending : India’s public expenditure on healthcare is only 2.1% of GDP in 2021-22 while Japan, Canada and France spend about 10% of their GDP on public healthcare.
  • Unequal distribution: India’s health care system is concentrated in urban areas with very little presence in the rural areas where majority of the population lives.
  • Lack of Medical Research : In India, R&D and cutting-edge technology-led new projects receive little attention.
  • Low doctor-patient ratio: The doctor patient ratio in India is about 1:1500 much higher than the WHO norm of one doctor for every 1,000 people.
  • The private sector also provides for 58 percent of the hospitals and 81 percent of the doctors in India.

Govt of India Initiatives to improve healthcare sector in the country :

  • Pradhan Mantri-Ayushman Bharat Health Infrastructure Mission (PM-ABHIM) : it aims to strengthen India’s health infrastructure and improve the country’s primary, secondary and tertiary care services.
  • Ayushman Bharat : Follows a two- pronged approach by Creation of health and wellness centres to bring health care closer to homes.
  • formulation of a Pradhan Mantri Jan Arogya Yojana (PMJAY) to protect poor and vulnerable families against financial risk arising out of health episodes.
  • Ayushman Bharat Digital Mission: aims to connect the digital health solutions of hospitals across the country. Under this, every citizen will now get a digital health ID and their health record will be digitally protected.
  • National Ayush Mission : it is a centrally sponsored scheme for the  development of traditional medicines
  • Pradhan Mantri Swasthya Suraksha Yojana (PMSSY) :aims to correct regional imbalances in the availability of affordable/reliable tertiary healthcare services and also to augment facilities for quality medical education in the country.

Way Forward:

There is an urgency to focus on all the three levels of primary, secondary and tertiary healthcare, it is imperative that the government look towards improving primary health care as a public good.

The lesson emerging most unequivocally from the pandemic experience is that if India does not want a repeat of the immeasurable suffering and the social and economic loss, we need to make public health a central focus.

There is also a need to declutter policy dialogue and provide clarity to the nomenclatures.  India needs to move beyond the doctor-led system and Para medicalise several functions. India should focus on technology upgradation and preventive care to further its march towards healthy India.

Source: The Hindu

Previous Year Questions

Q.1) Consider the following:

  • Aarogya Setu

Which of the above are built on top of open-source digital platforms? (2022)

  • 1 and 2 only
  • 2, 3 and 4 only
  • 1, 3 and 4 only
  • 1, 2, 3 and 4

Q.2) With reference to recent developments regarding ‘Recombinant vector Vaccines’, consider the following statements:

  • Genetic engineering is applied in the development of these vaccines.
  • Bacteria and viruses are used as vectors.

Which of the statements given above is/are correct? (2021)

  • Both 1 and 2
  • Neither 1 nor 2

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Insights into Editorial: Making the private sector care for public health

what_it_entails

Context: Present healthcare system:

As India enters the second week of a national lockdown imposed in response to COVID-19, it is still unclear how well prepared the healthcare system is in dealing with the pandemic . Given the resource constraints of both the Central and State governments, it is clear that government hospitals alone will not be able to manage the fallout . Moreover, even within the government system, tertiary care and public health are the weakest links.

Necessity: Universal Health Services free of charge:

At present, the government has put a cap on the cost at Rs.4,500 per test, which is a burden for even a middle-class patient. The poor will clearly have no access to this and the government itself does not have adequate facilities to meet the increasing demand. It is here that the government needs to ensure that there is no cost to the patient. The governments at the Centre and in States have to take responsibility for providing universal health services free of charge and accessible to all . This will require governments to not just expand the capacity within the public sector, but also to tap into the available capacity in the private sector . Faced with a serious health emergency , the silence of the government on the expected role of the private sector is intriguing.

Recommendation by National Health Authority:

  • The National Health Authority has recommended that the testing and treatment of COVID-19 be included in the PM-Jan Arogya Yojana (PM-JAY) but this proposal is still awaiting clearance.
  • The governance of the health service system is clearly fragmented and has created anxiety among the public.
  • There is lack of a visible central command , which should be created under the supervision of the Union Health Minister, aided by a team of experts.
  • They should be tasked to make policies as and when required and communicate them to State governments, taking into account an evolving situation.
  • There have been some tentative measures taken by States to allow individuals seeking testing for COVID-19 to access private laboratories at subsidised rates.
  • At this point, and certainly before the lockdown is lifted, it is absolutely essential that adequate testing and quarantine facilities are created.

Comprehensive National Policy to ensure that Private Healthcare Capacity:

  • A preparedness plan has to address all levels of care in terms of infrastructure, equipment, testing facilities and human resources in both the public and private sectors.
  • However, so far, the Central and State governments have given little indication of bringing an increase in public expenditure on health.
  • So, an already overburdened public health system will be unable to meet the increase in moderate and severe cases of COVID-19 that would require hospitalisation.
  • While some individual private sector companies have come forward with offers of creating capacity and making it available to COVID-19 patients, there is a need for a comprehensive national policy to ensure that private healthcare capacity is made available to the public.
  • Some States like Chhattisgarh, Rajasthan, Madhya Pradesh and Andhra Pradesh have already roped in the private sector to provide free treatment.

NITI Aayog’s ‘Model Concession Agreement for Setting Up Medical Colleges Under the Public Private Partnership’ guideline document: To address shortage of qualified doctors and bridge gap in medical education , the NITI Aayog has come out with the public-private partnership model to link new or existing private medical colleges with functional district hospital to augment medical seats.

Example: Private corporate sector hospitals under public control : The Spanish parallel

  • Consider the experience in Spain. The Spanish government issued an order bringing hospitals in the large private corporate sector under public control for a limited period.
  • This tough decision was taken with the understanding that existing public healthcare facilities would not be able to cope with the sudden, if short-term, rise in COVID-19 cases.
  • In Britain, given the rise in the number of COVID-19 cases, the health workforce in the National Health Service has been under a lot of pressure.
  • British trade unions have demanded that the government make the 8,000 beds in 570 private hospitals in the country available.
  • They have argued that while beds in private hospitals are lying empty, there is severe shortage of beds in the public hospitals.
  • The unions have also been critical of the U.K. government decision to rent these beds at an exorbitant cost to the exchequer.

Can the Spanish practise is necessary for India?

The government may argue that treatment for COVID-19 has been included under Ayushman Bharat , and this will take care of the poor .

But, what about the large, differentiated middle class , many of whom are employees in the services sector?

They do not have secure employment, nor do they have insurance cover . Crisis situations help reveal deeper realities to societies.

Road Ahead:

The Central government has already taken over some private hotels to accommodate persons quarantined for COVID-19. One way of expanding such facilities would be for the government to ‘take over’ private corporate laboratories and hospitals for a limited period.

A graduated approach to this is possible by asking tertiary private hospitals to create ICU facilities and isolation wards to care for the moderate and severe cases under the supervision of the government.

The political directive for such a move needs to come from the Central government while ensuring that the Ministry of Health provides standard treatment protocols for health personnel.

Conclusion:

In India, private corporate hospitals have, in the past, received government subsidies in various forms and it is now time to seek repayment from them .

They are also well poised to provide specialised care and have the expertise and infrastructure to do so.

Universal public healthcare is essential not only to curb outbreaks, but also to ensure crisis preparedness and the realisation of the promise of right to health .

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  • v.12(3); 2023 Jul
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Impact of COVID-19 on healthcare system in India: A systematic review

Megha kapoor.

1 Laboratory of Disease Dynamics & Molecular Epidemiology, Amity Institute of Public Health, Amity University, Noida, Uttar Pradesh, India

Karuna Nidhi Kaur

Shazina saeed.

2 Amity Institute of Public Health, Amity University, Uttar Pradesh, Noida, India

Mohd Shannawaz

Amrish chandra.

Despite an extensive healthcare system in India, the COVID-19 Pandemic created havoc upon the existing Indian healthcare system by disrupting the supply of essential healthcare services to patients. It has also highlighted the significant-quality discrepancies of healthcare facilities between the rural-urban areas and between public and private healthcare providers. The not so advanced healthcare system of India was exposed through the lack of oxygen and essential drugs required for the treatment of COVID-19. Additionally, during the pandemic period there was a drastic decline in seeking non-COVID-19 disease related healthcare services. The objective of this systematic review is to determine whether COVID-19 has impacted the healthcare system in India.

Introduction

India, the second most populous country in the world has been severely impacted by the ongoing COVID-19 pandemic since it’s emergence. COVID-19 has impacted every sector in the country including healthcare. Indian healthcare system crumbled under the massive burden of the global pandemic highlighting the gaps and challenges in the existing health delivery system.

COVID-19 or Coronavirus is an upper respiratory tract infection of high virulence. It was formerly known as ‘2019-nCoV’ and is caused by the SARS-CoV-2 virus. 1 It first originated from Wuhan city, Central Hubei province of China in December 2019. Several clusters of patients with viral pneumonia of unknown origin were reported to be epidemiologically associated with the Hunan seafood market, Wuhan, China. 2 Soon, cases of pneumonia were reported in other parts of the world as it spread rapidly crossing the borders of China. A massive number of people started losing their lives in China and following its spread to other countries; it was declared a public health emergency of international concern on 30th January 2020 by World Health Organization (WHO). After more than 118,000 cases in 114 countries, and 4291 people lost their lives, COVID-19 was declared as a pandemic by World Health Organization (WHO) on 11th march 2020. 3 As the countries continued to struggle with a lack of resources and capacity the viral outbreak spread rapidly worldwide, infecting millions of people all across the globe including India.

Those infected with Coronavirus disease (COVID-19) exhibit a varying range of symptoms ranging from mild to moderate. It affects people of all ages; however, the risk of serious infection increases with advancing age. Patients infected with coronavirus disease and presenting with pre-existing co-morbidities such as diabetes, asthma and cardiovascular diseases (CVDs) are more vulnerable to experiencing unfavourable outcomes or experiencing death.

A healthy individual can acquire COVID-19 infection directly by coming in close contact with an infected individual through the droplets emitted during sneezing or coughing. It can also be transmitted indirectly after coming in contact with contaminated surfaces such as door knobs. It affects every individual differently with cough, fever, sore throat, tiredness and lethargy being the most common symptoms of the illness. Individuals can also develop few lesser common symptoms such as loss of taste, diarrhoea, irritation of the eyes and rash on the skin among others. An individual can develop shortness of breath or experience difficulty in breathing and requires urgent medical attention. These symptoms may take 4–5 days to appear after coming in contact with a virus or as long as 14 days and can also be asymptomatic.

The first wave

In India, the first case of COVID-19 infection was reported on 27TH January 2020, when a 20 year old female with a travel history of China presented with a sore throat and dry cough in the emergency department of General Hospital, Thrissur, Kerala. 4 Since then, COVID-19 has taken a serious toll in India and worldwide. To prevent the spread of COVID-19 infection, the Government of India announced a nationwide lockdown for 21 days on 24 March 2020, which was further extended. It was not until 30th May, that the government uplifted the restrictions in an ‘unlock’ phase-wise manner. Throughout, national advisories were generated and the norm of ‘social distancing’ and ‘work from home was introduced. People were advised to practise social distancing, wear masks and avoid going out unnecessarily and only people of ‘essential services such as doctors, nurses, police and home services were exempted. These preventive measures allowed the Indian Healthcare delivery system to prepare for the pandemic. These measures stopped the further spread of COVID-19 infection and the efforts of the Indian Government to contain the viral spread were applauded internationally. India has experienced three COVID-19 pandemic waves till now with a massive surge during the second wave in March 2021. 5

The second wave and Indian healthcare system

The first wave had a low infectivity rate since the lockdown was imposed and individuals practised social distancing. Therefore, it largely affected the economy and livelihoods of Indians without any serious implications on the healthcare system. However, during march 2021, the country witnessed the most dangerous second wave that created havoc as individuals started taking preventive measures more casually due to ‘pandemic fatigue’. This was characterized by an increasing number of cases between 25 and 50 years of age, a shortage of essential medicine and equipment, and medical professionals. 6 Indian healthcare system failed to meet daily oxygen demand, Intensive Care Units (ICU) beds and oxygen beds due to which many hospitals had to turn the patients away, resulting in higher mortality rates. This lead to the disruption of routine immunization procedures, and treatment of Non-communicable and communicable diseases. 7 This revealed the overstretched and overburdened existing Indian Healthcare system. This also highlighted the failing healthcare management system and lacking public health system and efficient healthcare models in India. The Indian government failed to respond to the second wave effectively unlike the first wave.

The third wave of COVID-19 in India

With the emergence of the new Omicron variant of SARS-CoV2, the cases increased in January 2022. 8 The majority of the cases were asymptomatic or mildly symptomatic. With increased administration of the COVID-19 vaccine, the patients admitted in ICU were mostly unvaccinated or with pre-existing co-morbidities. The demand for hospital beds, oxygen beds and ventilators were low and mostly remained unoccupied.

The third wave was different from the first two waves due to various factors such as low virulence of the omicron variant despite high transmissibility and administration of either single or both doses of COVID—19 vaccine to the adult population, authenticating the effectiveness of the vaccine.

Therefore, the COVID-19 pandemic has significantly disrupted the healthcare systems in India. Hence, this review aims to describe the impact of COVID-19 on the healthcare system concerning the patient visit and reception of treatment, diagnostic tests done and referral services in India. It is necessary to conduct this review as it will aid in developing new healthcare models in order to manage the COVID-19 pandemic at present and prevent any further waves from arising in the future.

Health care system in India

A sound and effective healthcare system enable the country to respond to a pandemic efficiently by overcoming the challenges and barriers encountered in providing healthcare.

The Indian healthcare system is a mixed framework, including both public and private healthcare service providers. However, a large proportion of private healthcare providers are present in urban India, providing, secondary and tertiary healthcare services. 9

The objective of this systematic review is to determine the impact of the COVID-19 pandemic on the healthcare system in India.

Rationale: The rationale for this study is to investigate the impact of the COVID-19 pandemic on the healthcare system in India, considering the challenges, gaps and disruptions experienced during this global health crisis.

Material and methods

Study design.

This systematic review was conducted on the available online published studies in high-quality journals related to COVID-19 impact on healthcare services in India.

Search strategy

A thorough extensive literature search was conducted between 14 February 2022 and 20 February 2022 on the electronic database ‘PubMed’ for quality studies published between time period 2019 and 2022 using the search strategy (impact) AND (COVID-19) AND (healthcare system) OR (Primary Health centre)) OR (secondary health centre)) OR (community health centre)) OR (tertiary health centre))) OR (hospital)) OR (government)) OR (private)) AND (India).

The following keywords and Medical Subject Headings (MeSH) entries were used:

COVID-19, healthcare system, India.

Studies that met the eligibility criteria were selected based on the inclusion and exclusion criteria after screening the database for this systematic review.

Inclusion and exclusion criteria

This systematic review included the studies conducted in the English language during the COVID-19 Pandemic assessing the healthcare system in India. Studies involving outpatient clinics visit, hospital admissions, diagnostic tests done, minor and major surgeries and case referrals were also included.

Studies which were conducted in private clinics & not involving government, primary, secondary and tertiary centres, along with the studies conducted on the physical & mental health status of healthcare providers through surveys were excluded as shown in Table 1 .

Summary of excluded studies.

Data extraction

After completion of the initial screening process, a total of seven articles were selected to be included in this systematic review. The study selection process is illustrated in Figure 1 , representing the PRISMA (Preferred reporting items for systematic reviews and meta-analysis) flow diagram for this systematic review.

An external file that holds a picture, illustration, etc.
Object name is 10.1177_22799036231186349-fig1.jpg

PRISMA flow diagram of the systematic search.

From the selected articles following data was extracted by preparing an MS Excel spreadsheet: title of the study, study objectives, study methodology and conclusion.

Table 2 shows the summary of all the included articles in this systematic review.

Summary of included studies.

According to the objective of this systematic review the results described based upon the Impact of the COVID-19 Pandemic on the health care system in India on various parameters – number of outpatients, number of inpatients, number of patients undergoing minor and major surgeries, emergency trauma cases, patients undergoing nonurgent elective procedures.

Impact of COVID-19 on cancer care in India

From the seven included articles in this review, two articles described the disrupted oncology services in India by comparing these before and during the pandemic. A cohort study to describe the impact of COVID-19 on cancer care in India compared the oncology services provisions by cancer patients between 01 March 2020 and 01 March 2020 with similar duration for 2019 and concluded that there was a 54% reduction in new patient registration, 46% reduction in patient follow-up visit, 36% reduction in hospital admissions, 37% reduction in outpatient chemotherapy, 49% reduction in number of major surgeries, 52% reduction in minor surgeries, 23% reduction in patients accessing radiotherapy, 38% reduction in pathological diagnostic testing, 43% reduction in radiological diagnostic tests and 29% reduction in palliative care referrals. It also found that there was more reduction of oncology services for larger metro cities than smaller cities. 10 Another study, A retrospective analysis from western India determining the impact of the COVID-19 lockdown on Cancer care stated reduced patient visits and number of treatments received during the lockdown with chemotherapy being the most common treatment received. 11

Impact of COVID-19 on nephrology services in India

Only one study out of the seven included studies described the impact of the COVID-19 pandemic on nephrology and transplant services at a tertiary care centre, in Ahmedabad, India. The study concluded that there was significant reduction in a number of outpatients and inpatients between April 2020 and June 2020 when compared with a similar duration in 2019 almost by 50%. There was also a reduction in donor transplants, haemodialysis and nonelective procedures such as renal biopsies and arteriovenous fistulas during March 2020. 12

Impact of COVID-19 on ophthalmic care in India

Three out of seven included studies reported the impact of COVID-19 on ophthalmic care in India. A study conducted at a tertiary care ophthalmic institute in India reported a decrease of 97.14% in the routine patient visit, a decline of 35.25% in emergency outpatient visits, a decrease in routine and emergency ward admissions by 95.18% and 61.66% respectively, a reduction of elective surgeries by 98.18%, decrease of 58.81% in emergency surgeries, reduction of 99.61% in the number of donor corneas collected between 25 March 2020 and 15 July 2020 with comparison on previous year data of the same duration. 13 A study conducted in rural eye centres of Southern India reported that between 23 March 2020 and 19 April 2020, the total number of patients reduced during the lockdown-I period versus pre-lockdown. Only essential procedures were performed and most of the patients were treated for conjunctivitis. 14 A third study, which was conducted in a tertiary eye care Institute reported that there was a reduction in the number of patients presenting with ocular trauma in their emergency department during the lockdown as compared to the previous year. 15

Impact of the COVID-19 pandemic on the clinical practice of trauma and orthopaedics

A single epidemiology study out of seven studies included in this article, which was conducted at a tertiary care centre in New Delhi, explained various outcomes of the COVID-19 pandemic on the practice of orthopaedics and trauma through comparison between the pandemic period and pre-lockdown. It stated a reduction by 71.93% in outpatient attendance, a reduction of 59.35% in inpatient admissions, 55.78% reduction in surgical procedures including arthroplasty surgery, trauma and arthroscopic surgery during the pandemic period. 16

This study is being conducted to investigate the impact of the COVID-19 pandemic on the health care system in India by a systematic review approach based upon the eligibility criteria, seven articles related to the purpose of the study were screened after inclusion and the final analysis was prepared. The included studies defined various parameters – number of outpatients, number of inpatients, number of patients undergoing minor and major surgeries, emergency trauma cases, patients undergoing nonurgent elective procedures, follow-up visits for assessment of the impact of the COVID-19 pandemic on overstretched and overburdened health care system Of India. The studies included in this article reported that the COVID-19 pandemic has sharply affected the health care services in India including cancer care, nephrology services, ophthalmic care, trauma practice and orthopaedics care.

The COVID-19 Pandemic has led to a disrupted healthcare system which has subsequently impacted non-COVID disease conditions. The observed reduction in the number of new patient registrations, hospital registrations, major and minor surgeries, and transplant procedures as summarized in various studies during March 2020–April 2020 could be due to fear of infection among patients. The patients residing in rural parts of India found it difficult to access health services in metro cities due to travel restrictions during the lockdown period and this has led to delays in early screening, correct diagnosis and appropriate treatment which is of grave concern. These patients may present with advanced stages of the disease and create a backlog of patients by overloading the healthcare system.

Hospitals faced certain challenges that inhibited them from providing appropriate care to the patient such as- many hospitals being converted to COVID-19 dedicated treatment facilities and as result, they faced a widespread shortage of Personal Protective Equipment (PPE) supplies. Hospitals reported a shortage of adequate staff as they were themselves exposed to the virus. Various hospitals reported lack of necessary medical equipments such as ICU beds and Ventilators which was a major threat.

Despite the lockdown and various challenges encountered, hospitals realized the need of improving the accessibility of healthcare through teleconsultation along with in-person visits during these challenging times. In the absence of direct consultations to the patients, telemedicine was conducted to address the concerns of outpatients and therefore, reduce their need to visit the hospital.

In general, the COVID-19 Pandemic has posed a serious threat to all aspects of the healthcare system in India by affecting the activities of hospitals that provide treatment services to patients for non-COVID-19 diseases.

The results of this study show that Indian Healthcare System during the COVID-19 pandemic has suffered serious challenges, which can be a wake-up call because due to delayed diagnosis, a large number of patients will present with advanced stages of the non- covid-19 disease such as cancers, which may require emergency treatment. Strengthening of the Indian healthcare system is required so that it does not crumble under future pandemics if any. Need of the hour is a robust healthcare model and effective healthcare policies with regular updates to manage the current pandemic along with more emphasis on telemedicine as this is not the last pandemic that India will face. In conclusion, the COVID-19 pandemic has significantly impacted the healthcare system in India.

Limitations of the study: This study has limitation regarding language inclusion, as the researchers’ proficiency was limited to English, resulting in the exclusion of articles written in other languages. Another major limitation is the bias as the he papers relies on available online published studies in high-quality journals, which may introduce a bias towards studies that have been published and accessible. There may be relevant studies that have not been included in the review, potentially leading to a skewed representation of the impact of COVID-19 on the healthcare system in India.

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding: The author(s) received no financial support for the research, authorship, and/or publication of this article.

Ethical statement: No Ethical approval is needed.

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UPSC Key—21st February, 2024: Article 142 of the Constitution, Definition of Forest and Semiconductor industry in India

Exclusive for subscribers from monday to friday: why t n godavarman judgment and forest (conservation) act 2023 are relevant to the upsc exam what significance do topics like subsidy for fisheries in india, biennial multilateral naval exercise (milan) and global initiative on digital health (gidh) have for both the preliminary and main exams you can learn more by reading the indian express upsc key for february 21, 2024..

essay on health sector in india upsc 2020

Important topics and their relevance in UPSC CSE exam for February 21 , 2024 .  If you missed the February 20, 2024 UPSC CSE exam key from the Indian Express, read it here

FRONT PAGE SC quashes Mayor poll results, rules in favour of Cong-AAP candidate

essay on health sector in india upsc 2020

Preliminary Examination:  Indian Polity and Governance-Constitution, Political System, Panchayati Raj, Public Policy, Rights Issues, etc.

Main Examination:  General Studies II: Salient features of the Representation of People’s Act.

Key Points to Ponder:

• What’s the ongoing story- THE SUPREME Court Tuesday quashed and set aside the result of the January 30 mayoral polls for the Chandigarh Municipal Corporation in which the presiding officer had named BJP ’s Manoj Sonkar as the winner, and instead declared Kuldeep Kumar, the AAP-Congress coalition candidate, as the validly elected candidate. It also issued a show cause notice to Anil Masih, the presiding officer, on why steps should not be initiated against him under Section 340 of the Code of Criminal Procedure, 1973.

• The Supreme Court said what?

Festive offer

• On what grounds did the court strike down the result?

• What is Article 142 of the Constitution?

• Why Supreme Court invoked Article 142 in this issue?

• The Supreme Court of India invoked the extraordinary power conferred on the court under Article 142 of the Constitution in this case-What is that “Extraordinary Power” granted to Supreme Court under Article 142 of the Indian Constitution?

• Article 142 of the Constitution and ‘complete justice’-How Article 142 ensures ‘Complete Justice’?

• Can High court use Article 142?

• Why Supreme Court criticised Anil Masih?

• Why was this mayoral election important?

• For Your Information- A three-judge bench presided by Chief Justice of India D Y Chandrachud perused the ballot papers and said that the eight ballots on which Masih had made a marking, and were later counted as invalid, were duly cast in favour of Kuldeep Kumar. Kumar had approached the Supreme Court against the outcome of the election.

Setting aside the January 30 election results as “contrary to law”, the bench — comprising Justice J B Pardiwala and Justice Manoj Misra —however refused to quash the entire electoral process. “We are of the considered view that it would be inappropriate to set aside the election process in its entirety when the only infirmity which has been found is at the stage when the counting of votes was recorded by the presiding officer. Allowing the entire election process to be set aside would further compound the destruction of fundamental democratic principles which has taken place as a consequence of the conduct of the presiding officer.”

Accordingly, it said, “We are of the considered view that in such a case, this court is duty bound, particularly in the context of its jurisdiction under Article 142 of the Constitution to do complete justice to ensure that the process of electoral democracy is not allowed to be thwarted by such subterfuges. Allowing such a state of affairs to take place would be destructive of the most valued principles on which the entire edifice of democracy in our country depends. We are therefore of the view that the court must step in in such exceptional situations to ensure that the basic mandate of electoral democracy, albeit at the local participatory level is preserved.”

The Supreme Court said it was evident that Masih “is guilty of a serious misdemeanour in doing what he did in his role and capacity as presiding officer”. “The presiding officer has evidently put his own mark on the bottom half of the ballot for the purpose of creating a ground for treating the ballot to have been invalidly cast. In doing so, the presiding officer has clearly acted beyond the terms of his remit under the statutory regulations…,” it said.

Masih, who was the presiding officer, had told the court on Monday he had put the mark on the ballot papers as they were already defaced, so as to avoid them being mixed up with the other ballots. Referring to this, the order said, “In this court yesterday, the presiding officer made a solemn statement that he had done so because he had found that each of the ballots was defaced. As already recorded, it is evident that none of the ballots have been defaced.”

“The conduct of the presiding officer has to be deprecated at two levels. Firstly, by his conduct, he has unlawfully altered the course of the Mayoral election. Secondly, making a solemn statement before this court on February 19, 2024, the presiding officer has expressed a patent falsehood for which he must be held accountable,” it said.

• What was the role of Anil Masih in Chandigarh mayoral polls?

• Presiding Officer-What you know about the same?

• What is the role of Presiding Officer?

• Who appoints Presiding Officer in district?

Other Important Articles Covering the same topic:

📍 Art 142, why SC quashed Chandigarh mayor election, why it matters

Maharashtra clears 10% Maratha quota; Shinde says it will survive the test of law

Preliminary Examination:  Indian Polity and Governance-Constitution, Political System, Panchayati Raj, Public Policy, Rights Issues, etc.

Mains Examination:  General Studies II: Government policies and interventions for development in various sectors and issues arising out of their design and implementation.

• What’s the ongoing story- The Maharashtra Assembly Tuesday unanimously passed a Bill granting 10 per cent reservation in education and jobs to the Maratha community.

• Maharashtra State Reservation for Socially and Educationally Backward Classes Bill 2024-Know key features

• Do You Know- The principle of creamy layer will be applicable and reservation under this Act will be available only to those in the Socially and Educationally Backward Classes who are not in the creamy layer category. The report submitted to the government last week by commission chairman Justice (retired) Sunil Shukre said “exceptional circumstances and extraordinary situations exist” and this warrants granting reservation to Maratha community in excess of 50 per cent.

In the Assembly, Shinde said there are 22 states that have over 50 per cent reservation. These include Tamil Nadu (69%), Haryana (67%), Bihar (75%). Currently, Maharashtra has 52 per cent reservation – SC (13%); ST (7%), OBC (19%), Vimukt Jati (3%), Nomadic Tribe B (2.5%), Nomadic Tribe C (3.5%); Nomadic Tribe D (2%); and Special Backward Classes (2%). Besides, 10 per cent is reserved for the EWS category and with the addition of 10 per cent for Marathas, total reservation in the state will reach 72%. The commission arrived at the conclusion that the Maratha population accounts for 28 per cent in the state.

The committee to determine the status of the Marathas was set up in December 2023 with Justice (retd) Sunil B Shukre of the Bombay High Court as chairperson. Over the past two months, the Commission claims to have surveyed 1,58,20,264 families across the state.

The Shukre commission notes that the population of Marathas in the state is 28%, while 84 % of them are not advanced, adding that such a large backward community cannot be added into the OBC bracket. The Commission describes extreme poverty, decline in agricultural income, and partitions in land holdings as reasons for the current status of the Marathas. It also notes that 94% of farmers who have died by suicide in the state belonged to the Maratha community.

The panel finds inadequate representation of the community in all sectors of public services, and says the Marathas have remained “completely out of the mainstream” due to their backwardness. It calls for separate reservation to the Marathas to increase their representation in government jobs and developed sectors.

The Bill said the state government “on the basis of the exhaustive study by the Commission on various aspects regarding the Maratha community, the empirical, quantifiable and contemporary data, facts and statistics set out therein,” decided that the Maratha community is a Socially and Educationally Backward Class and shall be specified as such under Article 342A (3) of the Constitution of India and to provide reservation for that class under Articles 15(4), 15(5) and 16(4) of the Constitution.

The commission report recommended that the Maratha community needed a separate denomination of percentage, distinct and separate from existing reserved categories and left it to the state government to decide the percentage of reservation for the Maratha community.

In November 2018, when the government moved to grant 10 per cent reservation to the Marathas, it was granted on the recommendations of the Maharashtra Backward Class Commission headed by Justice (Retired) M G Gaikwad that had investigated the backwardness of the Maratha community. In 2021, a five-judge bench of the Supreme Court noted that the Gaikwad commission report had certain shortcomings and the conclusion arrived at by the commission was not borne out by the data and material before it. The Maharashtra government’s new Bill stated that it had made note of all Supreme Court observations.

• What is Maratha reservation issue?

• What are the Marathas demanding?

• What is the History and Status of the Maratha Reservation Demand?

• Who are the Marathas?

• Why Marathas demanding for reservation?

• For Your Information- In June 2019, the Bombay High Court upheld the constitutional validity of the Maratha quota under the Socially and Educationally Backward Classes (SEBC) Act, 2018. While ruling that the 16 per cent quota granted by the state was not ‘justifiable,’ the HC reduced it to 12 per cent in education and 13 per cent in government jobs, as recommended by the Maharashtra State Backward Class Commission.

The HC, however, said that the limit of reservation should not exceed 50%. However, in exceptional circumstances and extraordinary situations, this limit can be crossed. It said that this will be subject to availability of quantifiable and contemporaneous data reflecting backwardness, inadequacy of representation and without affecting the efficiency in administration.

The court heavily relied on the findings of the 11-member Maharashtra State Backward Class Commission (MSBCC) headed by Justice G M Gaikwad (retd). The commission surveyed nearly 45, 000 families from two villages from each of 355 talukas with more than 50 per cent Maratha population.

The report submitted on November 15, 2018 said the Maratha community is socially, economically and educationally backward. The HC expressed satisfaction over the data and observed that the commission had conclusively established the social, economic and educational backwardness of the Maratha community. It had also established inadequacy of representation of Maratha community in public employment in the state.

• In May 2021, a five-judge Constitution bench of the Supreme Court headed by Justice Ashok Bhushan struck down the provisions of Maharashtra law providing reservation to the Maratha community-Why?

• What is 1992 Indra Sawhney (Mandal) judgment?

• One immediate demand from the Marathwada region is that the state government should grant Kunbi status to all Marathas-Why?

📍 Maratha reservation: A long history of political tug-of-war and litigation

📍 Third time lucky? Why the new law is unlike two previous bids to provide reservation to Marathas

GOVT & POLITICS

WHO launches digital health platform agreed upon in India’s G20 presidency

Preliminary Examination:  Economic and Social Development-Sustainable Development, Poverty, Inclusion, Demographics, Social Sector Initiatives, etc.

Main Examination:  General Studies II: Issues relating to development and management of Social Sector/Services relating to Health, Education, Human Resources.

• What’s the ongoing story – Achieving one of the three priority areas agreed upon during India’s G20 presidency in 2023, the World Health Organization (WHO) Tuesday launched the Global Initiative on Digital Health (GIDH) virtually, a platform for sharing knowledge and digital products among countries.

• What is Global Initiative on Digital Health (GIDH)?

• Global Initiative on Digital Health (GIDH)-Know its key objectives

• Global Initiative on Digital Health (GIDH) will be a network of networks with four main components-what are those?

• G20 New Delhi Leaders’ Declaration-What were the key takeaways on health?

• What is Digital Health?

• What are the benefits of Digital Health Technologies?

• What are key issues faced by the healthcare sector of India?

• India’s Health Budget -Know the Statistics

• How does the pandemic affected health services?

• How does the impact of the pandemic on health services put the spotlight on the benefits of digital innovation and technology-enabled solutions?

• How implementation of Ayushman Bharat Digital Mission (ABDM) united all stakeholders in the digital healthcare ecosystem?

• Public Health Systems in India-Know the Background

• Current state of India’s health infrastructure- What World Bank data says?

• Steps required to strengthen the existing state of Health infrastructure in India

• What do you understand by Universal Health Coverage (UHC)?

• PM Atma Nirbhar Swasth Bharat Yojana and Ayushman Bharat Scheme-Key Highlights

• Is there any explicit/implicit recognition of the right to health or healthcare under the Constitution? (Hint: Directive Principles of State Policy in Part IV of the India Constitution provide a basis for the right to health)

• What is Supreme Court of India stand on Right to Health?

📍 Turning the spotlight on health

EXPRESS NETWORK

At Milan-24, Navy offers its submarine rescue capability

Preliminary Examination:  Current events of national and international importance

• What’s the ongoing story- Indian Navy is offering its submarine rescue capabilities to friendly countries, a key highlight of the ongoing multilateral naval exercise Milan-24 in Visakhapatnam that will further India’s defence diplomacy.

• What is MILAN?

• Why biennial Multilateral Naval Exercise (Milan) is important?

• MILAN and SAGAR initiative-Connect the dots

• For Your Information- As many as 51 countries, 11 heads of maritime agencies, and warships and an aircraft from 15 countries will participate in the Indian Navy’s mega multi-national exercise MILAN. The 51 countries include new participants such as Canada, Spain, Germany, Italy, Iraq and Yemen in the exercise, which comes in the backdrop of a new set of security challenges in the Gulf of Aden, including a series of drone and missile attacks on merchant ships in the recent months.

The Navy has also carried out a series of anti-piracy operations in the Arabian Sea in recent weeks. In the 12th edition of MILAN, the 51 participating countries will be sending their operational units and delegations. As per the Navy, 15 ships and one Maritime Patrol Aircraft from friendly foreign countries, including Bangladesh, Sri Lanka, Russia, US, Iran, Myanmar, Malaysia and France, will participate in the sea exercise. From the Indian Navy, nearly 20 ships, including aircraft carriers Vikrant and Vikramaditya, and nearly 50 aircraft will participate in the exercise.

📍 Military exercises boost India’s diplomatic interests, provide platform for sharing strategies

‘Small scale fishing should be exempted from WTO talks’

Preliminary Examination:  Economic and Social Development

Mains Examination:  General Studies II: Bilateral, regional and global groupings and agreements involving India and/or affecting India’s interests.

• What’s the ongoing story- Ahead of the WTO’s inter-ministerial meeting in Abu Dhabi later this month, the National Fishworkers Forum (NFF’s) has written to the commerce and industry ministry asking it to protect the interest of small fishermen by pushing World Trade Organization (WTO) to keep small scale fishing out of fisheries subsidies negotiations later this month.

• What is the subsidy for fisheries in India?

• What is India’s stand on fisheries subsidies?

• Fishing Industry in India-Know present scenario of Indian fisheries

• Marine fisheries in India vs Inland fisheries in India-compare and contrast

• Do You Know- According to the Central Marine Fisheries Research Institute (CMFRI), as per Census 2016, the country’s marine fisherfolk population is 3.77 million, comprising approximately 0.90 million families. Nearly 67.3 per cent of these families were in the below poverty line (BPL) category.

• Twelfth ministerial conference of the World Trade Organisation (WTO) and the Agreement on Fisheries Subsidies (AFS)-Know in detail

• Why Agreement on Fisheries Subsidies (AFS) is first-of-its-kind?

• Know the significance of the adoption of Agreement on Fisheries Subsidies (AFS)

• Agreement on Fisheries Subsidies (AFS) and Sustainable Development Goal (SDG) 14.6-connect the dots

• Agreement on Fisheries Subsidies (AFS) prohibits three kinds of subsidies. What are they?

• What is India’s demand on overcapacity and over-fishing (OCOF)?

• What Comprehensive Marine Fishing Policy of 2004 headed by Dr. B. MeenaKumari and the existing Guidelines for deep-sea Fishing in the Exclusive economic zones says about fisheries subsidies?

• What is the WTO and the Ministerial Conference?

• For Your Information- The World Trade Organization is the only international organization that deals with the rules of trade between countries. Founded in 1995, the WTO is run by its 164 members, and according to its rules, all decisions are taken through consensus and any member can exercise a veto.

Its aim is to promote free trade, which is done through trade agreements that are discussed and signed by the member states. The WTO also provides a forum for countries to negotiate trade rules and settle economic disputes between them. The Ministerial Conference is the WTO’s top decision-making body and usually meets every two years. All members of the WTO are involved in the MC and they can take decisions on all matters covered under any multilateral trade agreements.

• “The public stockpiling of food grain is the longest pending issue”-Why?

• What is India’s stand?

• ‘Peace clause’ agreed during the Bali ministerial in 2013-What was that?

• Dispute settlement mechanism (DSM)-what you about the same?

• What happened in the 12th WTO ministerial meeting?

• “A permanent solution at WTO will give India and a coalition of developing countries the flexibility to give out higher farm support”-Analyse

• “Giving out higher farm support could land India into legal disputes at WTO on account of distorting global trade”-Discuss

• Why India is very keen on a permanent solution?

• For Your Information- A permanent solution at WTO will give India and a coalition of developing countries the flexibility to give out higher farm support. This assumes special significance as farmers are holding yet again protests in the national capital seeking a law to guarantee minimum support price ( MSP ) for all crops. Several farmers groups have long held the opinion that India should walk out of WTO.

However, giving out higher farm support could land India into legal disputes at WTO on account of distorting global trade. India is already facing pushback from the Cairns Group — a group of agricultural exporting countries that include Australia, Brazil and Canada who claim that India’s public stockholding (PSH) programme is highly subsidised, especially for rice, and that this is affecting food security of other countries.

“The main reason why India is very keen on a permanent solution is that some of the provisions in the peace clause are ambiguous. So we don’t know how those provisions will be interpreted by a WTO panel. That creates uncertainty and unpredictability for us. Our invoking the peace clause from 2020 onwards has been subjected to detailed questioning by many countries. The objective is to make the peace clause more restrictive,” Abhijit Das, expert on international trade and former head, Centre for WTO Studies said.

India has invoked the ‘peace clause’ several times at the WTO for breaching the prescribed 10 per cent subsidy ceiling on rice procurement. India’s subsidy on rice had exceeded the threshold on multiple occasions forcing it to invoke the ‘peace clause’ agreed during the Bali ministerial in 2013 which allows developing countries to breach the 10 per cent ceiling without invoking legal action by members.

“Cairns Group is also pushing all countries to cut agriculture support by 50 per cent by 2030 which will result in countries such as India making huge sacrifices compared to developed countries,” Das said. He added if a scheme was not existing in 2013 then that can be implemented but the products benefiting for the scheme cannot exceed the 10 per cent subsidy ceiling. This means that for those products, the peace clause will not be applicable.

“The peace clause says that you are distorting trade due to your subsidies but nobody will sue you provided you meet certain conditions. The conditions include that a country should not hurt the food security of other countries or be trade distorting. These conditions are vague in nature and that is why India can be taken to dispute. This is the reason why India and other developing nations are pushing for a permanent solution,” Ranja Sengupta, Senior Researcher with the non-profit international research body Third World Network (TWN) said on Thursday.

Government officials had earlier said that India will not discuss any other issues on agriculture as long as the issue of permanent solution is not resolved. Developed and developing nations continue to differ on the subject of domestic support for farmers so much so that the WTO Director-General, Ngozi Okonjo-Iweala in November last year said that ongoing agriculture negotiations have “failed to achieve” the progress WTO members have called for.

📍 ‘Permanent solution for public stockholding top priority for India’

Defining forests, saving them

Preliminary Examination:  Current events of national and international importance.

Main Examination: 

• General Studies II: Government policies and interventions for development in various sectors and issues arising out of their design and implementation.

• General Studies III: Conservation, environmental pollution and degradation, environmental impact assessment.

• What’s the ongoing story- The Supreme Court has directed governments to follow the “broad and all-encompassing” definition of forest as laid down in its 1996 judgment in the T N Godavarman case until a consolidated record of all kinds of forests across the country is prepared.

• What is “forest”?

• Do You Know- The global standard for “forest” is provided by the Food and Agriculture Organisation (FAO) of the United Nations: at least 1 hectare of land with a minimum of 10% per cent tree canopy cover. While the FAO does not include areas “predominantly under agriculture or urban land use” in a forest, India counts all 1-hectare plots with 10% canopy cover “irrespective of land use” as forest. The FSI is not the only one looking at India’s forest cover. Over the years, several independent studies have reported significant loss of forests in India. According to Global Forest Watch, a World Resources Institute platform, India lost 1,270 sq km of natural forest between 2010 and 2021.

• What is the India State of Forest Report?

• For Your Information- India is one of the few countries to have a scientific system of periodic forest cover assessment that provides “valuable inputs for planning, policy formulation and evidence-based decision-making”. Since 19.53% in the early 1980s, India’s forest cover has increased to 21.71% in 2021. Adding to this a notional 2.91% tree cover estimated in 2021, the country’s total green cover now stands at 24.62%, on paper.

• Why was the Forest (Conservation) Act amended in 2023?

• How exactly did the Supreme Court define ‘forest’ for the purposes of the Act?

• To what extent did the SC’s 1996 judgment really expand the ambit of the FCA, 1980?

• What about the argument that following the T N Godavarman judgment, the FCA was impeding the government’s welfare agenda?

• Who challenged the 2023 amendments to the law, and on what grounds?

• What is the Forest (Conservation) Amendment Bill, 2023?

• How the Forest (Conservation) Amendment Bill, 2023 is different from the Forest (Conservation) Act, 1980?

• The Forest (Conservation) Amendment Bill, 2023-What are the objectives?

• For Your Information- On March 29 2023, the government introduced The Forest (Conservation) Amendment Bill, 2023 in Lok Sabha to make changes to The Forest (Conservation) Act, 1980. It was passed on July 27 and is now awaiting passage in the Rajya Sabha .

Diversion of forests for the construction of roads, railway lines or other projects of strategic nature near India’s international borders would no longer require clearance once the bill becomes law. It exempts certain kinds of infrastructure or development projects from the need to get forest clearance, which is mandatory at present. The amendment bill also renames the parent legislation, the Forest (Conservation) Act, 1980, to Van (Sanrakshan Evam Samvardhan) Adhiniyam which translates to Forest (Conservation and Augmentation) Act.

Besides being in Hindi, the new name is a reflection of a new focus on afforestation and reforestation activities with the objective of increasing India’s forest cover and fulfilling its international commitment of creating an additional carbon sink of 2.5 to 3 billion tonnes by 2030. The predominant idea of the proposed changes is to build forest carbon stock by raising plantations. The Bill also seeks to make land available for developers to meet their legal obligation towards compensatory afforestation in lieu of forest land diverted for development projects. The Bill tries to achieve both these objectives by restricting the applicability of the FC Act, and by freeing up land that is currently locked up as unrecorded forests.

• What is the 33 percentage of the forest policy?

• “With only 21 per cent of India’s land area having forest cover and even more worryingly, only 12.37 per cent intact natural forest, we have a long way to go to meet our target of 33 per cent forest cover”-Discuss

📍 Forests and national security

FINALLY, A CHIP FABRICATION PLANT IN INDIA? THE PROGRESS SO FAR

Preliminary Examination:  General issues on Environmental ecology, Bio-diversity and Climate Change

• General Studies III: Infrastructure: Energy, Ports, Roads, Airports, Railways etc.

• What’s the ongoing story- After initial hopes of finally securing a viable bid to set up a semiconductor fabrication facility in India tapered off owing to numerous challenges, a fresh wave of proposals have rekindled hopes yet again. Minister of State for Electronics and IT Rajeev Chandrasekhar recently confirmed that the Tata Group and Israeli chip company Tower Semiconductor have applied to set up foundries in the country.

• What are the proposals currently on the table?

• What had happened to the earlier fab proposals?

• Why is India focusing on semiconductor manufacturing?

• What factors may contribute to potential challenges in the domestic semiconductor manufacturing ecosystem?

• What makes Semiconductors the most important commodities in the global market right now?

• What is the supply chain for semiconductors?

• What are the steps in the semiconductor supply chain?

• Which nation holds the distinction of being the primary source of semiconductors on a global scale?

• “A key element of the partnership is the resolve to diversify the global semiconductor supply chain, which is at the centre of the rivalry between the world’s number 1 and 2 economic powers, the US and China”-What do you understand by this?

• What is semiconductor?

• What is the most basic component of a semiconductor chip?

• Semiconductors are the foundation of nearly every modern electronic gadget. Where does India stand in the semiconductor industry?

• The Government of India has undertaken several initiatives to promote electronics manufacturing-Know the important schemes

• What are the current challenges of the semiconductor industry in India?

📍 Why India’s semiconductor manufacturing industry is yet to take off

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SP-Congress seat sharing

After weeks of tense negotiations and hard bargaining, the INDIA alliance partners Samajwadi Party (SP) and Congress finalised their seat-sharing pact in Uttar Pradesh for the upcoming Lok Sabha elections. Under their agreement, the Congress will contest 17 seats out of 80 in the state, leaving the remaining 63 seats for the SP and its smaller allies.

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COMMENTS

  1. Health Sector in India

    The healthcare industry in India includes hospitals, medical tourism, health insurance, medical equipment, telemedicine, outsourcing, clinical trials, and medical gadgets. The public and private sectors make up the two main components of India's healthcare delivery system. Table of Contents The Scenario of the Health Care Sector in India

  2. Healthcare Sector in India

    What is the Scenario of the Healthcare Sector in India? About: Healthcare industry comprises hospitals, medical devices, clinical trials, outsourcing, telemedicine, medical tourism, health insurance and medical equipment. India's healthcare delivery system is categorised into two major components - public and private.

  3. Public Health System In India

    GS Paper - 2 Health Government Policies & Interventions Issues Relating to Development This article is based on "Reset and reform" which was published in The Indian Express on 29/04/2020. It talks about the importance and challenges of the public health system amid Covid-19 pandemic.

  4. Overview of Indian Healthcare Sector

    What are the Updates in Indian Health Sector? Leprosy: India has eliminated Leprosy as a public health problem, according to the World Health Organization criterion, there must be less than one case per 10,000 population at the national level, the criterion set in 2005 stated.

  5. Health Care Sector in India

    The size of Indian Healthcare sector is expected to reach $ 280 billion by 2020 as per some reports. Healthcare industry in India comprises hospitals, medical tourism, health insurance, medical equipment, telemedicine, outsourcing, clinical trials, medical devices.

  6. Insights Weekly Essay Challenges 2020

    Insights Weekly Essay Challenges 2020 - Week 35: "Despite Challenges, To be a Healthy and Successful Nation, India must Ensure Universal Health Coverage " Insights Weekly Essay Challenges 2020 - Week 35 Archives 31 May 2020 Write an essay on the following topic in not more than 1000-1200 words:

  7. Problems pertaining to Healthcare sector in India

    India's expenditure on the health sector has risen meagerly from 1.2 per cent of the GDP in 2013-14 to 4 per cent in 2017-18. The National Health Policy 2017 had aimed for this to be 2.5% of GDP. The health budget has neither increased in real terms nor is there any policy to strengthen the public/private sector in deficit areas.

  8. Health Sector in India

    Lack of Public Expenditure: India is currently spending only 1.2% of its GDP on the health sector. This reflects the low level of political commitment for ensuring health care and how it has never been an electoral issue. Prices of Drugs: Even when medical services and expertise is available and affordable, an average citizen in India spends a ...

  9. Healthcare scenario in India

    Healthcare scenario in India. The World Health Organization defines health as a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. At present, India's health care system consists of a mix of public and private sector providers of health service s. Networks of health care facilities at ...

  10. Health system in India

    Health System in India Healthcare has become one of India's largest sectors, both in terms of revenue and employment. The Indian healthcare sector is growing at a brisk pace due to its strengthening coverage, services and increasing expenditure by public as well private players.

  11. Health Care Sector in India: Growth, Government Schemes & Ayushman

    The hospital industry, a significant part of the healthcare sector, is estimated to achieve a value of about $132 billion by 2022. Private sector contributions account for 74% of the total expenditure in the healthcare sector. The medical tourism segment in India is growing at an 18% rate and is predicted to reach $9 billion by 2020.

  12. Issues relating to development and management of Health

    The Indian medical tourism market was valued at USD 2.89 billion in 2020 and is expected to reach USD 13.42 billion by 2026. Telemedicine is also expected to reach USD 5.5 billion by 2025. According to some estimations, the Indian healthcare sector will be worth $774 billion by 2030.

  13. Issues related to Health Sector in India

    • The National Health Mission, India's flagship plan for primary health care, is still in a bad place overall. • The NHM's part of the health budget dropped from 73% in 2006 to 50% in 2019 because States didn't raise their health spending in the same way and by the same amount. Without a whole-person approach, healthcare:

  14. In Depth

    India's Healthcare System. The healthcare delivery system is categorised into two major components: public and private. The public healthcare system is made up of secondary and tertiary care institutions in key cities and provides basic healthcare facilities in the form of Primary Healthcare Centres in rural areas.; The private sector provides the majority of secondary, tertiary, quaternary ...

  15. India's Health Sector

    In the Economic Survey of 2022, India's public expenditure on healthcare stood at 1% of GDP in 2021-22 against 1.8% in 2020-21 and 1.3% in 2019-20. India had 7 physicians per 1,00,000 people in 2017 (in contrast to 98 in Pakistan, 100 in Sri Lanka and 241 in Japan).

  16. Insights into Editorial: Making the private sector care for public health

    Context: Present healthcare system: As India enters the second week of a national lockdown imposed in response to COVID-19, it is still unclear how well prepared the healthcare system is in dealing with the pandemic. Given the resource constraints of both the Central and State governments, it is clear that government hospitals alone will … Continue reading "Insights into Editorial: Making ...

  17. India health system review

    Overview India has made significant improvements in the health outcomes of its people. Life expectancy at birth increased to 69.6 years in 2020, from expected 47.7years in 1970. MMR declined from 301 to 130 per 100 000 live births between 2003 and 2014-16, and IMR declined from 68 in the year 2000 to 24 per 1000 live births in 2016.

  18. Health and Budget

    India spent 1.8% of its GDP on health in FY 2020-21 and 1-1.5% in the previous years. As compared with the OECD countries' average of 7.6% and other BRICS countries' average of 3.6% on their health sector, this is considerably low. As a result, India is among the top nations with the highest Out Of Pocket Expenditure (OOPE).

  19. Impact of COVID-19 on healthcare system in India: A systematic review

    COVID-19 has impacted every sector in the country including healthcare. Indian healthcare system crumbled under the massive burden of the global pandemic highlighting the gaps and challenges in the existing health delivery system. COVID-19 or Coronavirus is an upper respiratory tract infection of high virulence.

  20. PDF NATIONAL HEALTH PROFILE 2022

    Government. Data on health sector parameters enables the health system to take a holistic view on policies and programmes and helps in enhancing health outcomes. The 17th edition of Annual Publication "National Health Profile - 2023" provides useful and relevant information on six important broad indicators concerning Health Sector.

  21. UPSC Key—21st February, 2024: Article 142 of the Constitution

    Exclusive for Subscribers from Monday to Friday: Why T N Godavarman judgment and Forest (Conservation) Act 2023 are relevant to the UPSC Exam? What significance do topics like subsidy for fisheries in India, biennial Multilateral Naval Exercise (Milan) and Global Initiative on Digital Health (GIDH) have for both the preliminary and main exams? You can learn more by reading the Indian Express ...

  22. State of India's Health Sector

    The sector will be driven by life expectancy, shift in disease burden, changes in preferences, growing middle class, increase in health insurance, medical support, infrastructure development and policy support and incentives. As of 2021, the Indian healthcare sector is one of India's largest employers as it employs a total of 4.7 million people.