Introduction & Summary
India's healthcare sector, a vast and complex ecosystem, is undergoing a transformative phase, driven by the imperative to achieve Universal Health Coverage (UHC) and leverage technology for improved access and efficiency. This module provides a comprehensive overview of healthcare delivery and the pivotal role of technologies in India. It delves into the overarching National Health Policy (NHP 2017) and its key objectives, and examines the structure and interventions of the National Health Mission (NHM). A significant focus is placed on the flagship Ayushman Bharat Program, particularly its two pillars: Health and Wellness Centres (HWCs) for comprehensive primary healthcare and PM-JAY for health insurance. The module also explores the ambitious Ayushman Bharat Digital Mission (ABDM) and the e-Sanjeevani telemedicine platform, highlighting their building blocks, benefits, and challenges. Furthermore, it addresses the regulation and domestic manufacturing of medical devices, the integration of traditional medicine systems (AYUSH), and the critical aspects of healthcare financing and the roles of the private sector and NGOs, underscoring India's multi-pronged approach to health.
Core Content Deep Dive
National Health Policy (NHP) 2017
Approved in 2017 (previous policies in 1983, 2002).
Vision
Attain the highest possible level of health and well-being for all at all ages, through a preventive and promotive healthcare orientation in all developmental policies, and universal access to quality healthcare services.
Goals
- Progressive achievement of Universal Health Coverage (UHC).
- Increase public health expenditure to 2.5% of GDP by 2025.
- Achieve specific targets (life expectancy, IMR, MMR, NCDs, etc.).
Key Features:
Comprehensive Primary Healthcare (CPHC)
Universal Health Coverage
Public Sector Dominance
Digital Health
Quality of Care
Prevention & Promotion
Private Sector Engagement
AYUSH Integration
National Health Information System
Source: National Health Policy 2017 (MoHFW).
National Health Mission (NHM)
Launched in 2013 by MoHFW (subsuming NRHM & launching NUHM).
Objective: To achieve universal access to equitable, affordable and quality healthcare services that are accountable and responsive to people's needs, with special emphasis on vulnerable sections.
Objective: To provide accessible, affordable and quality healthcare to the rural population.
Key Interventions:
- ASHAs (Accredited Social Health Activists): Community health workers.
- Janani Shishu Suraksha Karyakram (JSSK): Free services for pregnant women & sick infants.
- Rashtriya Bal Swasthya Karyakram (RBSK): Child health screening.
- Strengthening PHCs, CHCs, District Hospitals.
- Mobile Medical Units.
Objective: To address the health needs of the urban poor and vulnerable populations.
Key Interventions:
- Establishing Urban Primary Health Centres (UPHCs).
- Outreach services for slum populations.
- Focusing on maternal & child health, NCDs.
Achievements:
Significant improvements in maternal and child health indicators (MMR, IMR, U5MR), increased institutional deliveries, strengthened primary healthcare infrastructure.
Source: MoHFW, NHM guidelines.
Ayushman Bharat Program (2018)
A flagship program aiming to achieve Universal Health Coverage (UHC) in India, with two interconnected pillars.
1. Health and Wellness Centres (HWCs)
Concept: Transform existing Sub-Centres (SCs) and Primary Health Centres (PHCs) into HWCs.
Objective: To provide Comprehensive Primary Healthcare (CPHC) closer to the community.
Services Provided (Expanded):
- NCD screening & management (diabetes, hypertension, cancers).
- Mental health services.
- Geriatric care.
- Palliative care.
- Eye and ENT care.
- Yoga and wellness activities.
Significance: Shifts focus to holistic primary care, brings NCD screening to grassroots, reduces OOPE.
2. Pradhan Mantri Jan Arogya Yojana (PM-JAY)
Concept: World's largest government-funded health insurance scheme.
Objective: Health cover of ₹5 lakh per family per year for secondary/tertiary care hospitalization to over 10.74 crore poor/vulnerable families.
Identification: Based on Socio-Economic Caste Census (SECC) 2011.
Mode: Completely cashless and paperless at empanelled hospitals.
Benefits: Reduces catastrophic out-of-pocket expenditure (OOPE), prevents impoverishment.
Nodal Agency: National Health Authority (NHA).
Source: National Health Authority (NHA), MoHFW, PM-JAY portal, PIB.
Ayushman Bharat Digital Mission (ABDM)
Announced as NDHM in 2020, renamed ABDM in 2021.
Objectives: To create a national digital health ecosystem supporting UHC efficiently, accessibly, inclusively, affordably, and safely.
Vision: A seamless online platform for healthcare services, improving efficiency, access, and data-driven policy making.
Key Building Blocks (Digital Health Infrastructure):
ABHA Number (Health ID)
14-digit unique ID linking health records.
Healthcare Professionals Registry (HPR)
Database of all healthcare professionals.
Health Facility Registry (HFR)
Repository of all health facilities.
Personal Health Records (PHR)
Individuals manage their digital health records.
Unified Health Interface (UHI)
Open network for health services.
Benefits:
- Improved Access & Continuity of Care
- Reduced Fraud
- Data-Driven Policy Making
- Efficiency (Paperless, Cashless)
- Patient Empowerment
Challenges:
- Digital Divide & Access
- Data Privacy & Security (DPDP Act 2023)
- Interoperability
- Standardization
- Trust & Adoption
- Unique Indian Challenges
Source: NHA, MoHFW, ABDM website, PIB.
Telemedicine & e-Sanjeevani Platform
Telemedicine: Delivery of healthcare services from a distance using ICT.
e-Sanjeevani Platform
Concept: India's national telemedicine service.
Scale: World's largest telemedicine network, over 15 crore teleconsultations (as of early 2023).
Types:
- e-Sanjeevani AB-HWC: Doctor-to-doctor tele-consultations.
- e-Sanjeevani OPD: Patient-to-doctor tele-consultations.
Benefits:
- Improved Access (Remote/Rural)
- Reduces Travel & Cost
- Reduces Burden on Hospitals
- Continuity of Care
- Expert Consultation
Limitations:
- Digital Divide (Connectivity, Literacy)
- Lack of Physical Examination
- Data Privacy & Security
- Medico-Legal Issues
- Trust Issues
- Bandwidth & Infrastructure
Source: MoHFW, e-Sanjeevani portal, news reports.
Medical Devices: Regulation & Manufacturing
Regulation (Medical Device Rules, 2017)
Context: Previously under Drugs and Cosmetics Act. Dedicated rules now exist.
Objective: Regulate manufacturing, import, sale, distribution ensuring quality, safety, efficacy.
Mechanism: Risk-based categorization, licensing, QMS, clinical investigation, post-market surveillance.
Body: Regulated by CDSCO.
Promoting Domestic Manufacturing (PLI Scheme)
Context: High import dependence (~80%).
Scheme: Production Linked Incentive (PLI) Scheme for Medical Devices (launched 2020).
Objective: Boost indigenous manufacturing, reduce import dependence.
Mechanism: Financial incentives on incremental sales of domestically manufactured devices.
Significance: 'Atmanirbhar Bharat', jobs, healthcare accessibility.
Source: MoHFW, CDSCO, Dept. of Pharmaceuticals, PIB.
Traditional Medicine (AYUSH)
AYUSH: Acronym for Ayurveda, Yoga & Naturopathy, Unani, Siddha, Sowa-Rigpa and Homoeopathy.
Role:
- Healthcare Access (especially rural).
- Preventive & Promotive Health.
- Cultural Heritage.
Integration with Modern Medicine:
- NHP 2017 advocates mainstreaming.
- Co-location at HWCs & PHCs.
- Research Collaboration.
Research Efforts:
- Ministry of AYUSH (2014).
- Central Councils for Research.
- Scientific Validation efforts.
- COVID-19 role explored.
Source: Ministry of AYUSH, NHP 2017.
Healthcare Financing
Public vs. Private Expenditure
Public Expenditure: Historically low. NHP 2017 aims for 2.5% of GDP by 2025.
Private Expenditure: Dominant (household OOPE, private insurance, etc.).
Expenditure Overview (Illustrative)
Note: For dynamic charts, a JS library like Chart.js would be used.
OOPE (Out-of-Pocket Expenditure)
Concept: Direct payments by individuals at time of service use.
India's Burden: One of the highest globally (around 40-50% of total health expenditure).
Impact: Catastrophic health expenditures, poverty, hinders access.
Government Initiatives to Reduce OOPE:
- PM-JAY
- AB-HWCs
- Jan Aushadhi Kendras
- National Health Mission
Source: National Health Accounts, Economic Survey, WHO, MoHFW.
Role of NGOs & Private Sector
NGOs (Non-Governmental Organizations)
Role: Fill critical gaps, especially in remote/underserved communities.
Activities:
- Community health education, outreach.
- Primary care services, health camps.
- Disease-specific programs (TB, HIV).
- Advocacy, disaster response.
Private Sector
Dominant Provider: Over 70% outpatient, 60% inpatient care.
Strengths:
- Perceived higher quality, specialized services.
- Rapid response capacity.
Challenges:
- High costs, unregulated growth, transparency issues.
- Urban concentration.
NHP 2017 emphasizes strategic purchasing and regulation.
Source: MoHFW, NHP 2017, various health reports.
Prelims-Ready Notes
Goals: UHC, public health expenditure to 2.5% GDP by 2025. Key: CPHC, Digital Health, AYUSH integration.
Launched 2013. Subsumed NRHM (2005) & NUHM (2013). NRHM: Rural (ASHAs, JSSK). NUHM: Urban poor.
Two pillars. HWCs: Transform SCs/PHCs for CPHC (NCDs, mental health). PM-JAY: World's largest gov-funded health insurance. ₹5 lakh/family/year (SECC 2011). Cashless secondary/tertiary care. Nodal: NHA.
Launch 2020/2021. National digital health ecosystem. Blocks: ABHA Number, HPR, HFR, PHR. UHI. Benefits: Access, continuity, fraud reduction. Challenges: Digital Divide, Privacy (DPDP Act 2023), Interoperability.
National telemedicine. Types: e-Sanjeevani AB-HWC (doctor-to-doctor), e-Sanjeevani OPD (patient-to-doctor). Scale: >15 Cr teleconsultations. Benefits: Access, reduced travel. Limitations: Digital divide, no physical exam.
Regulation: Medical Device Rules, 2017 (CDSCO). Domestic Mfg: High import dependence (~80%). PLI Scheme for Medical Devices (2020).
Ayurveda, Yoga & Naturopathy, Unani, Siddha, Sowa-Rigpa, Homoeopathy. Ministry of AYUSH (2014). Role: Access, preventive/promotive. Integration at HWCs.
Public expenditure low. OOPE very high (~40-50% total health spending). Govt efforts to reduce OOPE: PM-JAY, AB-HWCs, Jan Aushadhi Kendras.
Private sector dominant provider (~70% outpatient, 60% inpatient). NGOs fill gaps.
Mains-Ready Analytical Notes
- UHC in India: Challenges despite Ayushman Bharat (funding, HR, quality, disparities).
- Public vs. Private Role: Balancing dominant private sector with strengthening public healthcare, regulation.
- Funding Deficit: Inadequate public spending (vs. 2.5% GDP target), high OOPE.
- Digital Health: Opportunities (ABDM, telemedicine) vs. Challenges (digital divide, privacy).
- AYUSH Integration: Scientific validation, effective integration, safety concerns.
- Medical Device Import Dependence: Strategic vulnerability, 'Make in India' challenges.
Shift to Comprehensive Care
From disease-specific programs to holistic primary healthcare (NHM, Ayushman Bharat).
Increasing Digitalization
From early e-health to comprehensive digital ecosystems (ABDM).
Growth of Private Sector
Post-liberalization dominance of private sector in healthcare provision.
Focus on Affordability & Access
Consistent theme in health policies, leading to schemes like PM-JAY.
COVID-19 Pandemic: Highlighted system fragilities, accelerated digital health, emphasized public health infra.
Demographic Dividend: Healthy population crucial for realizing India's demographic potential.
Economic Burden: High OOPE pushes millions into poverty, impacting economic growth.
'Atmanirbhar Bharat': PLI for medical devices, indigenous drug/vaccine manufacturing.
Sustainable Development Goals (SDGs): Contribution to SDG 3 (Good Health) and others.
Digital Public Infrastructure (DPI): ABDM as a prime example, showcasing India's global leadership.
- PM-JAY Health Cards distributed to millions.
- Over 1.6 lakh AB-HWCs operational by 2023.
- e-Sanjeevani's 15 crore teleconsultations.
- DPDP Act 2023 (Aug 2023) impacts ABDM and health data.
- PLI Scheme for Medical Devices attracting investments.
- National Health Accounts provide data on spending and OOPE.
- Health as a Right: Philosophical underpinning of UHC.
- Equity & Quality: Persistent challenges.
- Health Literacy: Importance for preventive health.
Current Affairs (Last 1 Year)
August 2023
Digital Personal Data Protection Act (DPDP Act) 2023
Enacted, significantly impacting ABDM and healthcare data. Mandates robust security, explicit consent, establishes Data Protection Board.
Ongoing 2023-24
Expansion of AB-HWCs
Network crossed 1.6 lakh operational centers, providing CPHC, NCD screening, tele-consultations.
Ongoing
PM-JAY Implementation Milestones
Continued increase in beneficiary base and cashless hospitalizations. Efforts to expand reach and ensure interoperability with ABDM.
Early 2023
e-Sanjeevani Telemedicine Growth
Surpassed 15 crore teleconsultations, highlighting acceptance of digital health solutions.
Ongoing 2023-24
Progress under PLI Scheme for Medical Devices
Companies setting up manufacturing units to reduce import dependence, boost 'Atmanirbhar Bharat'.
Ongoing
Integration of AYUSH Systems
Ministry of AYUSH continued efforts for integration, co-location at AB-HWCs, promoting research for scientific validation.
UPSC PYQs
Prelims
UPSC Prelims 2023: Consider the following statements:
1. 'Digital Public Infrastructure (DPI)' is a critical component of India's 'Digital India' programme.
2. 'Unified Payments Interface (UPI)' is an example of DPI.
3. 'Aadhaar' is an example of DPI.
How many of the above statements are correct?
Hint: ABDM is a key example of DPI in healthcare, making understanding DPI essential.
UPSC Prelims 2020 (Revised): With reference to 'e-Sanjeevani', consider the following statements:
1. It is a telemedicine service launched by the Ministry of Health and Family Welfare.
2. It enables doctor-to-doctor and patient-to-doctor tele-consultations.
3. It has completed over 10 crore teleconsultations (update: over 15 crore by early 2023).
Which of the statements given above are correct?
Hint: Tests knowledge of a key digital health platform. Numbers updated, core facts remain.
UPSC Prelims 2017 (Illustrative for PM-JAY, launched 2018): Consider the following statements regarding 'Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PM-JAY)':
1. It is the world's largest government-funded health insurance scheme.
2. It provides a health cover of ₹5 lakh per family per year for secondary and tertiary care hospitalization.
3. Beneficiaries are identified based on the Socio-Economic Caste Census (SECC) 2011 data.
Which of the statements given above are correct?
Hint: Direct question on a flagship healthcare program.
Mains
UPSC Mains 2023 (GS Paper III): Describe the key features of the 'Digital Personal Data Protection Act, 2023'. What are its implications for individuals and organizations in India?
UPSC Mains 2022 (GS Paper III): "The COVID-19 pandemic accelerated the adoption of digital health technologies globally." Discuss the potential benefits and challenges of integrating digital health technologies into India's healthcare system.
UPSC Mains 2019 (GS Paper III): "The Digital India programme has the potential to transform the Indian society, but it faces several challenges." Discuss.
Trend Analysis
Prelims Trends
- Highest Priority: Healthcare delivery & technologies.
- Flagship Schemes: Ayushman Bharat (HWCs, PM-JAY), NHM, ABDM.
- Digital Health: e-Sanjeevani, CoWIN.
- Policy & Targets: NHP 2017 goals (e.g., 2.5% GDP spending).
- Specifics of Schemes: Beneficiary ID, coverage, services.
- Current Affairs Linkage: New phases, milestones, legislation (DPDP Act).
Mains Trends
- UHC: India's efforts and multi-pronged approach.
- Dual Burden of Disease: Addressing communicable and NCDs.
- System Challenges: Funding gaps (high OOPE), HR shortages, quality, digital divide.
- Role of Technology: Evaluation of digital health (ABDM, telemedicine) - benefits & challenges.
- Policy Evaluation: Effectiveness of NHP and missions.
- "Atmanirbhar Bharat": Indigenous medical device manufacturing.
- Integration: AYUSH, public-private partnership.
Original MCQs for Prelims
1. Consider the following statements regarding 'Ayushman Bharat Health and Wellness Centres (AB-HWCs)':
1. They aim to provide Comprehensive Primary Healthcare (CPHC) closer to the community.
2. They primarily focus only on maternal and child health services.
3. Screening for Non-Communicable Diseases (NCDs) like diabetes and hypertension is part of the services offered.
Which of the statements given above are correct?
Explanation: Statement 1 is correct (CPHC). Statement 2 is incorrect; AB-HWCs expand services beyond MCH to include NCDs, mental health, etc. Statement 3 is correct.
2. Which of the following are key building blocks of the 'Ayushman Bharat Digital Mission (ABDM)'?
1. Ayushman Bharat Health Account (ABHA) Number
2. Healthcare Professionals Registry (HPR)
3. Health Facility Registry (HFR)
4. Unified Payments Interface (UPI)
Select the correct answer using the code given below:
Explanation: ABHA Number, HPR, and HFR are core building blocks of ABDM. UPI is part of broader DPI for payments, not a specific ABDM building block itself, though ABDM can leverage it.
Original Descriptive Questions for Mains
Key Points/Structure:
- Intro: Ayushman Bharat as flagship for UHC, two pillars.
- Role of HWCs (CPHC): Objective, Services (NCDs, mental health), Impact (reduces OOPE at primary level).
- Role of PM-JAY (Insurance): Objective (₹5 lakh/family), Mechanism (cashless), Impact (reduces catastrophic OOPE).
- Collective Aim: HWCs for primary care, PM-JAY for financial protection, creating continuum.
- Persistent Challenges:
- Funding Deficit (below 2.5% GDP).
- Human Resource Shortage.
- Quality of Care variations.
- Geographic Disparities.
- Digital Divide.
- High OOPE (despite PM-JAY for hospitalization).
- Private Sector Regulation challenges.
- Awareness & Uptake.
- Conclusion: Monumental step, but true UHC needs sustained investment, HRD, regulation, bridging gaps.
Key Points/Structure:
- Intro: Digital tech's transformative role.
- Objectives of ABDM: National digital health ecosystem, accessibility, efficiency, etc.
- Key Building Blocks: ABHA, HPR, HFR, PHR, UHI.
- Benefits: Improved Access & Continuity, Efficiency, Data-Driven Policy, Patient Empowerment, Fraud Reduction.
- Major Challenges:
- Digital Divide.
- Data Privacy & Security (DPDP Act 2023).
- Interoperability & Standardization.
- Trust & Adoption.
- HR Training & Infrastructure.
- Conclusion: ABDM's immense potential, but overcoming digital divide, ensuring privacy, and interoperability are crucial.