Health in India Notes for UPSC: National Health Mission, Ayushman Bharat PM-JAY, Mission Indradhanush, TB Elimination, Health Indicators, Institutions and Pandemic Lessons

Health is a basic human need and also the base of a country's economic development. In India, public health is a State subject, but the Centre guides the policy and funds many national programmes. For UPSC, the health topic appears as the Prelims questions on the schemes (Ayushman Bharat, National Health Mission, Mission Indradhanush), the diseases and the elimination goals, and the Mains questions on the health system, the insurance, the public expenditure and the lessons of the pandemic. These notes explain the health indicators, the National Health Policy, the main national programmes and schemes, the disease control programmes, the institutions and the challenges in simple language with the tables for quick revision.

Why Health Is a High-Yield Topic

The health sector connects the Social Justice (the poverty, the nutrition and the access), the Governance (the federal division of the responsibilities), the Economy (the expenditure and the insurance) and the Science and Technology (the vaccines and the digital health). It is a regular topic in the news, so UPSC questions follow the latest schemes. For more background, see our notes on and Human Diseases and Vaccines.

Key Health Indicators

India has shown a steady improvement in these indicators: the IMR, the MMR and the TFR have fallen, and the National Family Health Survey (NFHS-5) showed that the TFR had come down to about the replacement level. But the problems of the anaemia, the child stunting and the regional gaps remain serious. The Sample Registration System (SRS) and the NFHS are the key data sources.

National Health Policy, 2017

• The aim is to reach the highest possible level of the health and the well-being for all, through the universal access to the good quality health care.
• It stresses the preventive and the promotive care, and the "assurance" based approach.
• Targets include raising the public health expenditure to 2.5 per cent of the GDP by 2025, and the increase of the life expectancy at birth to 70 years.
• It gives priority to the primary health care and asks for the digital health, the integration of the AYUSH and the strengthening of the private sector partnership.

Major National Schemes and Missions

Disease Control and Elimination Programmes

• Tuberculosis: The National TB Elimination Programme (NTEP) aims to end the TB in India by 2025, five years ahead of the global target of 2030. Key tools are the Ni-kshay portal, the Nikshay Poshan Yojana (the cash support for nutrition) and the TB Mukt Bharat campaign. The BCG vaccine is for the TB prevention.
• HIV/AIDS: The National AIDS Control Programme (NACP) was run by the National AIDS Control Organisation (NACO, 1992). The HIV and AIDS (Prevention and Control) Act, 2017 protects the rights of the infected persons.
• Malaria: The National Framework for Malaria Elimination (2016 to 2030) aims at the elimination by 2030. Kala-azar (visceral leishmaniasis) and the lymphatic filariasis are also targeted for the elimination.
• Polio: India was declared polio-free by the WHO in 2014, with the Pulse Polio programme launched in 1995.
• Non-communicable diseases: The National Programme for the Prevention and Control of Non-Communicable Diseases (NP-NCD), for diabetes, cancer, cardiovascular disease and stroke; the National Tobacco Control Programme and the COTPA Act, 2003.
• Mental health: The National Mental Health Programme (1982) and the Mental Healthcare Act, 2017, which gives the right to the mental health care and has effectively decriminalised the attempt to suicide.

Legal and Regulatory Institutions

Lessons from the COVID-19 Pandemic

The pandemic exposed the weakness in the public health system, such as the shortage of the oxygen, the beds and the health workers, but it also showed the strength: the quick development and the production of the vaccines (the world's largest vaccination drive), the use of the digital tools (CoWIN, Aarogya Setu), the role of the front-line workers and the importance of the federal cooperation. It has led to a greater focus on the public health infrastructure, the surveillance, the research and the "One Health" approach (the link between the human, the animal and the environmental health).

Challenges of the Health System

• Low public health spending, which is about 2 per cent of the GDP or less, and the high out-of-pocket expenditure that pushes the families into poverty.
• The shortage of the doctors, the nurses and the specialists, with the urban-rural and the state-wise gaps.
• The dual burden of the communicable diseases and the fast-rising non-communicable diseases.
• Malnutrition, anaemia and the poor sanitation, and the air and water pollution that harm the health.
• Quality of care, the regulation of the private sector and the antimicrobial resistance.

The Mains Angle: Way Forward

A balanced Mains answer says that India has made progress in the vaccination, the maternal and child health and the insurance coverage, but the system needs a stronger base. Suggest: (1) increasing the public spending and the strengthening of the primary health care; (2) the human resource policy to train and retain the health workers in the rural areas; (3) the preventive action on the nutrition, the sanitation, the pollution and the lifestyle diseases; (4) the use of the digital health and the telemedicine with the privacy safeguards; (5) the regulation and the partnership with the private sector; (6) the convergence of the schemes and the community participation by the ASHAs and the panchayats. Link the answer with the SDG 3 (good health and well-being).

Previous-Year Style Practice

• Which scheme provides the health cover of Rs. 5 lakh per family? Answer: The Ayushman Bharat PM-JAY.
• In which year was India declared polio-free? Answer: 2014.
• Which programme aims to eliminate the TB in India by 2025? Answer: The National TB Elimination Programme.
• Which Act replaced the Medical Council of India? Answer: The National Medical Commission Act, 2019.

Frequently Asked Questions (FAQ)

What is the National Health Mission?

A mission, started in 2013 by combining the NRHM and the NUHM, to improve the health care in the rural and the urban areas.

What is Ayushman Bharat?

A scheme of 2018 with the Health and Wellness Centres and the PM-JAY health insurance.

How much cover does PM-JAY give?

Up to Rs. 5 lakh per family per year for the hospital care.

What is the aim of Mission Indradhanush?

To vaccinate the children and the pregnant women against the vaccine-preventable diseases.

Which programme works for the elimination of the TB?

The National TB Elimination Programme, with the target of 2025.

Who are the ASHA workers?

The Accredited Social Health Activists, the community health workers under the NHM.

Which law replaced the Medical Council of India?

The National Medical Commission Act, 2019.

What is the Mental Healthcare Act, 2017?

The Act that gives the right to the mental health care and effectively decriminalises the suicide attempt.

What is ABDM?

The Ayushman Bharat Digital Mission for the digital health records and the ABHA ID.

What is the target of the public health spending under the National Health Policy 2017?

2.5 per cent of the GDP by 2025.

What does the NFHS measure?

The National Family Health Survey collects the data on the fertility, the mortality, the nutrition and the health indicators.

How is this topic asked in UPSC?

As the schemes, the targets and the institutions in the Prelims, and as the problems and the reforms of the health system in the Mains.