The success or failure of any government in the final analysis must be measured by the well-being of its citizens. Nothing can be more important to a state than its public health; the state’s paramount concern should be the health of its people.
Franklin Delano Roosevelt
An effective public health system that can assure the nation’s health requires the collaborative efforts of a complex network of people and organizations in the public and private sectors, as well as an alignment of policy and practice of governmental public health agencies at the national, state, and local levels.
Public health infrastructure provides communities, states, and the Nation the capacity to prevent disease, promote health, and prepare for and respond to both acute (emergency) threats and chronic (ongoing) challenges to health. Infrastructure is the foundation for planning, delivering, evaluating, and improving public health.
Today the health infrastructure of India is in pathetic condition, it needs radical reforms to deal with new emerging challenges. On the one hand the role of private players is continuously increasing in the healthcare sector, but simultaneously healthcare facilities are getting costly, and becoming non-accessible for the poor. The government hospitals are facing the problem of lack of resources and infrastructure; there are inadequate number of beds, rooms, and medicines.
Why Is Public Health Infrastructure Important?
All public health services depend on the presence of basic infrastructure. Every public health program—such as immunizations, infectious disease monitoring, cancer and asthma prevention, drinking water quality, injury prevention—requires health professionals who are competent in cross-cutting and technical skills, up-to-date information systems, and public health organizations with the capacity to assess and respond to community health needs. Public health infrastructure has been referred to as “the nerve center of the public health system.”
While a strong infrastructure depends on many organizations, public health agencies (health departments) are considered primary players. Health agencies rely on the presence of solid public health infrastructure at all levels to support the implementation of public health programs and policies and to respond to health threats, including those from other countries.
Report on the Health Survey and Development Committee, commonly referred to as the Bhore Committee Report, 1946, has been a landmark report for India, from which the current health policy and systems have evolved.
The recommendation for three-tiered health-care system to provide preventive and curative health care in rural and urban areas placing health workers on government payrolls and limiting the need for private practitioners became the principles on which the current public health-care systems were founded. This was done to ensure that access to primary care is independent of individual socioeconomic conditions. However, lack of capacity of public health systems to provide access to quality care resulted in a simultaneous evolution of the private health-care systems with a constant and gradual expansion of private health-care services.
Although the first national population program was announced in 1951, the first National Health Policy of India (NHP) got formulated only in 1983 with its main focus on provision of primary health care to all by 2000. It prioritized setting up a network of primary health-care services using health volunteers and simple technologies establishing well-functioning referral systems and an integrated network of specialty facilities. NHP 2002 further built on NHP 1983, with an objective of provision of health services to the general public through decentralization, use of private sector and increasing public expenditure on health care overall. It also emphasized on increasing the use of non-allopathic form of medicines such as ayurveda, unani and siddha, and a need for strengthening decision-making processes at decentralized state level. Due to the India’s federalized system of government, the areas of governance and operations of health system in India have been divided between the union and the state governments. The Union Ministry of Health & Family Welfare is responsible for implementation of various programs on a national scale (National AIDS Control Program, Revised National Tuberculosis Program, to name a few) in the areas of health and family welfare, prevention and control of major communicable diseases, and promotion of traditional and indigenous systems of medicines and setting standards and guidelines, which state governments can adapt. In addition, the Ministry assists states in preventing and controlling the spread of seasonal disease outbreaks and epidemics through technical assistance. On the other hand, the areas of public health, hospitals, sanitation and so on come under the purview of the state, making health a state subject. However, areas having wider ramification at the national level, such as family welfare and population control, medical education, prevention of food adulteration, quality control in manufacture of drugs, are governed jointly by the union and the state government.
Understanding Public Health Infrastructure
Public health infrastructure can best be described by what it is and what it does. It includes three key components:
Public health infrastructure provides the necessary foundation for undertaking the basic responsibilities of public health, which have been defined as the 10 Essential Public Health Services:
Public health-care infrastructure in India
India has a mixed health-care system, inclusive of public and private health-care service providers.6 However, most of the private health-care providers are concentrated in urban India, providing secondary and tertiary care health-care services.
Primary health centers
Community health centers
First referral units
Schematic diagram of the Indian Public Health Standard (IPHS) norms, which decides the distribution of health-care infrastructure as well the resources needed at each level of care is shown below,
On the basis of the distributional pyramid, currently there are 722 district hospitals, 4833 CHCs, 24 049 PHCs and 148 366 SCs in the country.
The following data obtained from National Health Profile 2010 shows condition of health infrastructure in India:
India has been focussing on providing comprehensive care facilities to its citizens. It has framed policies that allow the design and implementation of programs in an inclusive manner. However, looking at the pace of achievements of the targets so far and future targets, it needs to focus more on framing of the policies in terms of building capacity of existing human resources, enhancing further allocation of finances dedicated toward newborn care, identifying areas through operational research, which can enhance quantity and quality of care for newborn care in India. The path is set and we need to operationalize and move forward.