The Hindu Editorial Analysis- 17th March 2025 | Current Affairs & Hindu Analysis: Daily, Weekly & Monthly - UPSC PDF Download

The challenges of public health education in India

Why in News?

• The reduction of U.S. funding for WHO and USAID has impacted global public health.
• Strengthening domestic public health education and employment is crucial for sustainable healthcare development.

Effect on Global Health and India

• The U.S. withdrawal from WHO and reduction in USAID funding have disrupted healthcare services in many low- and middle-income countries.
• India remains largely unaffected as international aid accounts for only 1% of its total health expenditure.
• However, this reduction in funding may shrink the public health development sector, which depends on international support.
• The decision impacts the job market for those pursuing Master of Public Health (MPH) and similar postgraduate courses.

Importance of Public Health in India

• Public health plays a crucial role in shaping healthcare delivery and improving people’s well-being.
• The Indian Constitution, through Article 47, mandates the government to improve public health.
• A trained workforce is essential for government, civil society organizations, academic institutions, and research bodies.
• The COVID-19 pandemic highlighted the urgent need for skilled public health professionals.

Growth of Public Health Education in India

• Public health education in India has roots in the colonial era, with early training embedded in medical education.
• The first specialized institution was established in 1932, but public health remained a part of community medicine.
• Many students pursued MPH courses abroad due to limited local training opportunities.
• The demand for MPH courses grew after the launch of the National Rural Health Mission (NRHM) in 2005.
• Today, over 100 institutions in India offer MPH courses, compared to just one in 2000.
• Despite this growth, government recruitment has not kept pace, making job opportunities scarce.

Challenges in Public Health Education and Employment

• A major issue is the mismatch between the number of MPH graduates and available jobs.
• Entry-level positions attract high competition, with few vacancies.
• The shrinking number of public health roles in government has worsened job scarcity.
• The private sector prioritizes hospital and business management over public health specialists.
• Research and development opportunities depend on foreign grants, which are decreasing as India is no longer a priority country.
• National funding for public health research is still in its early stages and remains inadequate.

Quality Concerns in MPH Education

• The rapid expansion of MPH institutions has led to quality concerns.
• Many students enroll without a clear understanding of the field, affecting their career prospects.
• Faculty members often lack practical experience in public health.
• The absence of a standard curriculum and regulatory oversight impacts training quality.
• MPH courses are not regulated by any national body like the National Medical Commission (NMC) or University Grants Commission (UGC).

Approaches to Strengthen Public Health Education and Employment

• Governments should create more public health jobs at all levels to strengthen healthcare systems.
• Establishing a dedicated public health cadre in State governments would improve employment opportunities and system efficiency.
• A specialized regulatory body should set curriculum standards and training requirements.
• Public health education should integrate practical learning within health systems.
• More institutions should be developed in States with limited or no public health training facilities.
• National efforts should focus on building strong local public health ecosystems to ensure sustainability.

From insurance-driven private health care to equity

Why in News?

India's healthcare system, as reflected in its budget, has been facing challenges, particularly in balancing private and public healthcare. The focus has been more on hospital care rather than primary healthcare, leading to increased reliance on the private sector and concerns about affordability.

Commitment to Universal Health Coverage

• India is dedicated to providing healthcare for all, in line with the World Health Organization's Universal Health Coverage (UHC) framework.
• The Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) was launched to reduce out-of-pocket expenses by offering insurance for hospitalization, surgeries, and tertiary care.
• However, this scheme primarily focuses on hospital-based care and overlooks the importance of primary healthcare (PHC), which is crucial for preventive and community-based health services.

Neglect of Primary Health Care (PHC)

• A robust PHC system is vital as it alleviates the pressure on hospitals and offers affordable healthcare to the public.
• The AB-PMJAY model promotes hospitalization over preventive care, leading to higher long-term healthcare costs.
• This strategy contradicts the Bhore Committee's recommendation of a pyramid-shaped healthcare system, with PHC at its base.
• Since 2018, more than 36 crore Ayushman cards have been issued, and over 31,000 hospitals have been empaneled under the scheme.
• However, there is a worrying trend of funds being diverted to private insurance companies, which diminishes state control over healthcare expenditures.
• The allocation of ₹9,406 crore for AB-PMJAY in the 2025 Budget represents a ₹2,000 crore increase from the previous year, furthering the trend of privatization in healthcare.

Privatization and Changes in the Insurance Sector

• The health budget for 2025 includes ₹95,957.87 crore for the Department of Health and Family Welfare and ₹3,900.69 crore for the Department of Health Research.
• There is a growing emphasis on medical education and digital infrastructure, while funding for the National Health Mission, which supports rural healthcare, is on the decline.
• This shift indicates a gradual reduction in the government's role in healthcare, with an increasing dependence on private entities.
• The insurance sector is being liberalized, with Foreign Direct Investment (FDI) limits raised to 100%. This aims to broaden insurance coverage, particularly in rural regions.

Challenges for Informal and Marginalized Workers

• The informal workforce and marginalized urban populations in India lack adequate health security.
• Many individuals are unaware of health insurance options, forcing them to rely on middlemen, which escalates their costs.
• Regulations in the private sector remain weak, resulting in higher medical expenses and uncovered costs.
• Essential healthcare workers, such as Accredited Social Health Activist (ASHA) workers, face uncertainty regarding their coverage under health insurance schemes.
• The absence of updated data, with the last Census conducted in 2011 and the most recent Periodic Labour Force Survey in 2020-21, hampers effective planning and resource allocation.

Lessons from Global Models

• Over-dependence on private insurance can lead to escalated healthcare costs and increasing inequalities, as observed in certain countries.
• Countries like Thailand and Costa Rica have successfully adopted public health insurance models, relying on general tax revenue and regulated private insurance to focus on primary and community-based healthcare.

The Need for Policy Reassessment

•  India needs to reevaluate its healthcare priorities to ensure adequate funding and support for preventive and primary healthcare. 
•  The government should shift its focus from tertiary private healthcare to investing in community-based health services to enhance affordability and accessibility. 
•  Policies should address the needs of informal workers, migrants, and vulnerable populations, particularly in light of climate-related health challenges. 
•  Safeguards must be established to control rising healthcare costs and reduce out-of-pocket expenses, reaffirming India's commitment to "Health for All." 

Tackling the problem of nutrition

Why in News?

• India’s nutrition challenge goes beyond food scarcity to encompass cultural and lifestyle factors.
• The emphasis should shift from targeted malnutrition programs to a comprehensive, inclusive public health-driven nutrition agenda.

Nutrition Challenges in India

• Nutrition is influenced not only by food availability but also by culture, caste, and gender relations.
• Current policies primarily address malnutrition among women and children, overlooking other groups such as men, senior citizens, and women outside the reproductive age.
• Non-communicable diseases (NCDs) like diabetes and hypertension, which result from poor nutrition, are often ignored.
• There are two types of nutrition deficiencies:
  • Insufficient Food: Some people do not have enough food.
  • Nutrient Deficiency: Others consume food lacking essential nutrients.

Alarming Nutrition Statistics

• India faces severe issues with child malnutrition and anemia among women.
• NFHS-5 data reveals:
  • 36% of children under five are stunted.
  • Only 11% of breastfed children (aged 6-23 months) receive an adequate diet.
  • 57% of women (aged 15-49 years) are anaemic.
  • 24% of women and 23% of men are overweight or obese.
  • 14% of people take medicines for diabetes.

Current Approach & Its Limitations

• Existing schemes offer take-home rations, supplementary foods, and iron-folic acid tablets.
• Poshan 2.0 targets aspirational districts and the North-East, reinforcing the idea that malnutrition is confined to specific areas and groups.
• A comprehensive approach is essential to address nutrition for all social strata, recognizing it as a public health issue.

Need for a Comprehensive Nutrition Strategy

• A broad nutrition policy should include:
  • Diverse Nutrition Needs: Identifying needs beyond maternal and child health.
  • Locally Sourced Solutions: Improving diets with nutrient-dense, affordable foods sourced locally.
  • Institutional Mechanisms: Ensuring effective nutrition delivery at the community level.

Role of Health and Wellness Centres (HWCs)

• HWCs can play a crucial role in implementing a universal nutrition agenda.
• Currently, they focus on nutrition support for pregnant and lactating mothers and children.
• Expansion is necessary to include all population segments, including the middle class.
• HWCs should ensure:
  • Wider Coverage: Expanding services across urban and rural areas.
  • Dedicated Staff: Having specialized staff for nutrition services.
  • Systematic Implementation: Following a structured approach to nutrition advice.

Key Factors for Success

• Engaging local elites to foster a sense of ownership.
• Integrating nutrition with local cuisines to promote better dietary habits.
• Learning from past public health campaigns that show community engagement and alignment with local practices enhance success rates.

Conclusion

• Nutrition should be viewed as part of overall health and well-being, not just a deficiency issue.
• A locally owned and well-integrated nutrition plan through HWCs can lead to improved health outcomes for all social groups.