Representative image of a hospital ward.
Credit: iStock Photo
A survey based on self-assessment carried out by the government has uncovered an unconscionable state of affairs countrywide: 80% of public health centres operating under the flagship National Health Mission (NHM) do not meet minimum standards with respect to staff, infrastructure, medicines and diagnostics.
There are 2.01 lakh public health centres in various categories, from sub-health centres to district hospitals. Of these, 40,451 undertook the self-assessment exercise. Approximately 20%, or 8,098, met the Indian Public Health Standards (IPHS). Failing to meet the minimum criteria, 17,100 facilities (42%) scored below 50, while 15,172 facilities (37.5%) scored between 50 and 80.
Provisionally, we can treat this survey as being representative, since it is random. Officials have indicated that the Centre proposes to carry out surprise checks to verify the claims made, but that is clearly not enough. Considering that only 20% of establishments participated in the self-assessment, it is imperative, first, to extend it by making self-assessment mandatory so that the government can get a handle on the actual situation.
It has also been said that the Centre plans to make 70,000 public health establishments IPHS-compliant in the first 100 days of the new government. This is clearly not enough, considering that there is a bigger challenge facing the government–making health institutions compliant with National Quality Assurance Standards (NQAS), a higher bar for health centres on best practices. If 80% of health centres fail to clear the first hurdle, it might be premature to conduct physical verification for NQAS compliance. What is needed is a much greater outlay for health in the upcoming Union budget, combined with clear goals and strict timelines.
We must keep in mind that though the health services did not crumble, they were badly exposed by the Covid-19 pandemic. There is no guarantee that another pandemic will not strike, given the way things have been progressing this century. Health outlay fell from 2.66% in 2022-23 to 2.06% in 2023-2024. In the interim budget for 2024-2025, the figure is 1.98%. The outlay must be boosted hugely to support health services at all levels. The National Health Policy, 2017, set an outlay goal of 2.5% to upgrade health infrastructure. But given the new challenge posed by the pandemic and India’s poor performance on indicators like child mortality, far greater spending is necessary. The coming budget is an opportunity to strengthen India’s public health sector.