Health-Care System in India :

Indian health-care system is out come of combination of Traditional health-care system and Modern health-care system. Because of this amalgamation Indian people are lower prescribed medication as compared to Developed Nation. This system is 'path of golden mean' for Indian health-care system.

India has had a tradition of health-care, with many notable physician like Dhanvantari, Jivika, Charaka and Susruta. This tradition has been carried on through various government schemes and program over the years. This situation demand now is to intensify primary health services and expand workforce. 

The right to health has so far not been accorded the status of a Fundamental Right to the Indian Citizens. It is not even a statutory right, unlike education. Health is a State Subject as per our Constitution. Health care funding - two-thirds of the total Governmental expenditure on health coming from the State Governments and balance one-third being provided by the Government of India.

Report on the Health Survey and Department Committee, commonly referred to as the Bhore Committee Report, 1946, has been a landmark report for India, from which the current health policy and system have evolved. The recommendation for three tiered healthcare system to provide preventive and creative Health care in rural and urban area placing health worker on government payrolls and limiting the need for private practitioner became the principles on which the current public health care system were founded. This was done to ensure that access to primary Health care is independent of individual socio-economic conditions. However, lack of capacity of public Health system to provide access to quality care resulted in a simultaneous evolution of the private healthcare system with a constant and gradual expansion of private healthcare services.

The National Health Policy of India got formulated only in 1983 with its main focus on provision of primary Health care to all by 2000. For establishing primary Health care services by using health volunteers, simple technologies and integrated network of specialty facilities. The objective of this health services are decentralization (general public participation). It also emphasize on increasing the use of non allopathic form of medicine such as Ayurveda, Unani, siddha and need for strengthening decision making process at decentralise state level.

In India 'Health' being a State subject, despite the issuance of the guideline by the central government, the final prerogative on implementation of the initiatives on newborn care lies with the states.

Due to federal form of government, the area of governance and operation of health system in India have been divided between the Union and the state governments. The Union Minister of Health and Family Welfare is responsible for implementation of various programs on bationat scale (National AIDS Control Program, Revised National Tuberculosis Program, etc) in the areas of health and family welfare, prevention and control of major communicable diseases and promotion of traditional and indigenous system of medicines and setting standard and guideline, which state governments can adapt. The Ministry assists states in preventing and controlling the spread of seasonal disease outbreak and epidemic through technical assistance. Despite the health is a state subject, the Union government at national level, such as family welfare and population control, medical education, prevention of food adulteration, quality control in manufacturer of drugs, are governed jointly by the union and the state government.

Public Health-care Infrastructure in India :

Indian health care system is mixed one (public and private health care system).
Whereas, most of the private healthcare providers are located in urban India, and providing secondary & tertiary health care services. The public health care infrastructure broadly reach in urban as well as rural areas has been developed as a three- tier system based on population norms.

Sub-centers :

A sub-health centers  (sub-centers) is the first contact point between primary health care system and the community. It is established in a plain area with a population of 5000 people and in hilly/desert/difficult to reach/tribal areas with population of 3000. At each sub-centers are require to be staffed by at least one midwife (ANM)/ female health worker and one male worker.
Under National Rural Health Mission (NRHM), there are require one additional ANM on a contract basis. Sub-centers mainly provide services in relation to maternal and child health, family welfare, nutrition, immunization, diarrhea control and control of communicable disease programs. The Ministry of Health & Family Welfare is providing 100% Central assistance to all the Sub-centers in the country since April 2002 in the form of salaries, rent & contingencies in addition to drugs & equipment.

Primary Health Centers :

A primary health center (PHC) is established in plain areas with a population of 30000 people and in hilly/difficult to reach/desert/tribal areas with a population of 20000. It is the first contact centre between the village community and the medical officer.  PHCs were provide preventive and curative health care to rural population. It is maintain by State Government under the Basic Minimum Service (BMS) Program. PHCs minimum requirements are one medical officer supported by 14 paramedical and other staff. Under NRHM, there is provision for two additional staff nurses  at PHCs on a contract basis. It has 4-6 beds for in-patients. PHCs provide health awareness and curative services.

Community Health Centers (CHCs) :

CHCs established and maintained by the State Government under the BMS program in a plain area with population of 120000 people and in hilly/desert/tribal areas with population of 80000. Under CHC, there are four medical specialists (surgeon, physician, gynecologist, pediatrician) supported by 21 paramedical and other staff. It has 30 beds with an operating theater, X-ray, labor room and laboratory facilities.

Emergency Unit :

It provides different facilities -
*Emergency ostetric care including surgical intervention such as caesarean sections
*Care for newborns
* Blood storage facilities on a 24 hours basis.

Currently there are -
722 districts hospitals,
4833 CHCs,
148366 SCs in the country.

National rural health mission (NRHM) :

It was launch in 2005, a greater shadow for the health sector in India. The main focus to reduce maternal and child mortality, it aimed at increased public expenditure on healthcare, decrease inequity decentralization and community participation in operationalization of healthcare facilities based on IPHS norms. It was make government commitment to raised public spending on health from 0.9% to 2-3% of GDP.
It's basic purpose to improve accessibility, affordability and accountability for rural people especially vulnerable sections like women and children. NRHM (2005-12) aimed to provide effective healthcare to rural population throughout country with special focus on 18 States having weak Public Health care infrastructure. Prioritize States and districts based on the status of infant and maternal mortality rates, these states are provided additional support both financially and technically. Gradual reform strategy strengthen the state health system.
Under NRHM for architectural correction of the rural health system -
availablity of human resources, program management, physical infrastructure, community participation, financing health care and use of information technology.
NRHM mainly focused on increasing the number of physicians, specialists, staff nurses, ANMs, medical college at graduate and post graduate levels. Physical infrastructure was enhanced by creating more health centres, newborn care units and renovating existing centres, which increased the capacity of health systems to treat more mothers and children. Formation of health committees at the village level and patient welfare committees  to strengthen community participation at public health-care facilities. Use information technology to track health of mother and child.

National Urban Health Mission (NUHM) :

* It was launch in May 2013 under National Health Mission.
* It is mainly focused on urban poor and vulnerable sections, by providing essential primary health care services and reducing extra expenses.
* The health care services targeting slums people.
* Institutional mechanism and management system to meet the health related challenges of rapidly growing Urban population.
* Partnership with community and local bodies for a more proactive involvement in Planning, implementation and monitoring of health activities.
* Partnership with NGOs, for profit and not for profit health service providers and other stakeholders.
NUHM would cover all State capitals, district headquarters and cities/towns with population of more than 50000.
The centre state funding pattern will be 75:25 for all the States except North Eastern states including Sikkim and other special category status of Jammu and Kashmir, Himachal Pradesh, Uttarakhand, for whom the centre-state funding pattern will be 90:10. The programme implementation plans (PIPs) and by the states are approved by the Ministry.

Ayushman Bharat : 

First major step towards National Health.
* It was launched on 25 September 2018.
*  Aim to create a healthy, capable and content new India.
* It is focused on the poor and vulnerable sections of the society.
* This scheme improving secondary and tertiary health care services for crore of Indians.
Two flagship initiatives under Ayushman Bharat -
A) Pradhan Mantri Jan Arogya Yojana (PMJAY) - 1.5 lakh health sub-center are being converted into health and wellness centers. It will cover more than 10 crore families, which is approximately 50 crore person.
B) National Health Protection Scheme (NHPS) : It will give coverage up to 5 lakh rupees per family, per year for secondary and tertiary health care hospitalisation.

Health Index : 

Health Index published by NITI Aayog (National Institution for Transforming India) with the help World Bank and Ministry of Health and Family Welfare.
* Tracking incremental performance on health outcomes and health system across all the States and UTs on an annual basis.
* In February 2018, the first round of the Health Index Report.
* Health Index is a weighted- composite Index based on 3 indicators -
1. Health Outcomes
2. Governance and Information
3. Key input and Processes
Out of three, Health Outcomes are most weighted across the different category of States/UTs.
* It will promote positive competitive federalism to increase health outcomes and encourage cross learning among states.
Healthcare Index in June 2019 : 
* Best Performing States & UTs in Health Index -
Large States - Kerala
Small States - Mizoram
UTs - Chandigarh
* Least Performing States and UTs in Health Index -
Large States - Uttar Pradesh
Small States - Nagaland
UTs - Daman & Diu

Limitations of  Health-care System in India :

* Poor condition of health care in country.
* lack of infrastructure.
* Poor health services in government hospitals.
* Private hospitals are costly/expensive.
* According to the Global Burden of Disease study, India is ranked low in health care index. India stand at a rank of 154.
* India spend less than 2% of her GDP on public health care.
* Lack of good governance.

Way forward for Health-care System in India :

* Accountability of Public and Private partnership.
* Interlinking health and development.
* Majority community address primary healthcare.
* To delivery of preventive, clinical and diagnostic healthcare services will result in early detection of cancer, diabetes and chronic conditions mostly needing long-term treatment and home care.
* This will further reduces demand for hospitalisation.
* Ayushman Bharat connected with Digital India. It will improve service delivery to the people.

India has been focussing on providing comprehensive care to poor people and vulnerable sections. Government allocating financial support for the operational research, new technology, enhance quantity and quality health care system. Health is wealth. In reality a healthy person is more able to take care of himself/herself and his/her family. The active participation of public health care and private health care system is making healthy and wealthy India. This will full fill Agenda 2030 of Sustainable Development (SDG 2030).

References :
E-book
Yojana