| UPSC Relevance 🟡Prelims: NRHM, VHSNCs, Mahila Arogya Samiti 🟡GS Paper II: Governance, Social Justice, Health Policies, Role of Civil Society 🟡GS Paper IV: Ethics in Public Administration, Participatory Governance |
Why in News
Recent doorstep health initiatives like Tamil Nadu’s Makkalai Thedi Maruthuvam (2021) and Karnataka’s Gruha Arogya scheme (2024, expanded in 2025) aim to deliver healthcare services for non-communicable diseases directly to citizens’ homes. While these programmes mark progress in accessibility, they raise critical questions on the extent of citizen participation in health governance and decision-making processes in India.
Background
Historically, health governance in India was largely a government-driven function. Over time, the process has expanded to include multiple stakeholders — civil society organisations, professional bodies, hospital associations, and trade unions.
To promote community participation, the National Rural Health Mission (NRHM) was launched in 2005, introducing formal platforms such as:
- Village Health, Sanitation and Nutrition Committees (VHSNCs) – for rural community health planning.
- Rogi Kalyan Samitis (RKS) – for hospital and health facility management.
- Mahila Arogya Samitis (MAS) – for women’s health issues in urban areas.
They were meant to be inclusive of women and marginalised groups, supported by untied funds for local needs. But many are inactive due to irregular meetings, poor coordination, unclear roles, underused funds, and social hierarchies.
Significance of Civic Engagement in Health Governance
What is Civic Engagement?
Active citizen participation in shaping decisions, policies, and services. In health governance, it means involving communities in planning, monitoring, and improving healthcare — making it with the people, not just for them.
1. Democratic Value: Upholds dignity, prevents epistemic injustice (undervaluing someone’s knowledge due to identity, e.g., ignoring a rural woman’s health insight because she isn’t formally educated), and enables citizens to influence health priorities.
2. Accountability & Transparency: Reduces elite capture and corruption, ensures resources reach the right people, and makes services more responsive.
3. Trust Building: Strengthens community–health worker relations, fostering respect and cooperation.
4. Better Outcomes: Increases service uptake in marginalised areas, improves maternal and child health, and boosts nutrition awareness.
Example: In Rajasthan, active VHSNCs improved maternal health by promoting institutional deliveries and nutrition awareness.
Challenges in Current Approach
1. Seeing People Only as Beneficiaries: Policies treat citizens as receivers of help, not partners in improving the system. For instance: If a village health plan is made in the district office without asking villagers about real problems like unsafe drinking water, people become passive recipients instead of co-creators.
2. Target-Focused Work: Governments focus on numbers (like vaccination counts) rather than whether services truly help. For instance: A health camp may report 500 diabetes tests, but without follow-up care, the community gains little benefit.
3. Top-Down Medical System: Leadership is dominated by doctors trained in Western medicine; public health skills are learned later and promotions depend on seniority, not skill. For instance: A senior doctor might get a public health post without experience in managing vaccination drives or coordinating village health workers.
4. Fear of Public Involvement: Officials fear more work, accountability, or activist disruption; big medical/business interests often dominate. For instance: When local women demand that a health centre stay open after 5 PM, officials may resist due to increased workload.
5. Weak Participation Platforms: Inactive or hard-to-access forums force citizens to turn to protests, media, or courts. For instance: If a VHSNC hasn’t met for two years, residents may approach newspapers or block roads to highlight medicine shortages.
Way Forward
1. Shift in Mindset: See communities as partners, not just tools to meet health targets. Value participatory processes as much as health outcomes. For instance: Involving villagers in planning a health camp ensures services match local needs.
2. Empowering Communities: Spread awareness about health rights and governance processes; run civic education in schools and villages; focus on marginalised groups; provide knowledge, tools, and resources for active participation. For instance: Community-led health mapping in tribal areas can highlight hidden service gaps.
3. Sensitising Health System Actors: Train administrators to avoid blaming low service use solely on “lack of awareness”; address deeper causes like poverty, caste bias, and gender discrimination. For instance: A district hospital improving maternal care by tackling transport and cost barriers, not just awareness campaigns.
4. Strengthening Platforms for Engagement: Reactivate VHSNCs, Mahila Arogya Samitis, and Ward Committees with regular meetings, transparent fund use, and inclusive representation; encourage collaboration between community representatives and health providers. For instance: Kerala’s Arogya Jagratha Samitis actively monitor service delivery, report gaps, and build community trust.
Conclusion
Reviving civic engagement in health governance is not just about improving service delivery; it is about restoring dignity, agency, and accountability in the system. Doorstep healthcare initiatives can succeed only when citizens are seen as co-creators, not mere consumers, of the health system. The future of India’s public health depends on making governance participatory, inclusive, and responsive at every level.
| RM Dose-Framework of Healthcare Regulation in India Historical Context: Health laws began under British rule (e.g., Madras Public Health Act, 1939). The Bhore Committee (1946) suggested integrated services and rural Primary Health Centres. Economic liberalisation (1991) expanded private healthcare, creating a need for stronger regulation. Regulatory Bodies: Ministry of Health and Family Welfare makes national policies. National Medical Commission oversees medical education and licensing (replaced Medical Council of India in 2019). Other bodies include Nursing Council and Pharmacy Council. Key Laws and Policies: 🟡Pre-Conception and Pre-Natal Diagnostic Techniques Act, 1994 (PCPNDT Act, 1994) – Prevents female foeticide. 🟡Clinical Establishments Act, 2010 – Mandates registration and standards. 🟡Drugs and Cosmetics Act, 1940 – Regulates medicines. 🟡Consumer Protection Act, 1986 – Includes healthcare as per Supreme Court ruling. 🟡National Health Policy, 2017 – Aims for universal health coverage. Major Challenges: Low public health spending (2.1% of GDP), high out-of-pocket costs (47.1%). Rural–urban gap in facilities. Rise in non-communicable diseases. Poor mental health support. Digital divide in telemedicine. Climate change health impact. Complex governance. Drug safety issues. Weak focus on prevention. Measures: Adopt risk-based regulation. Build rural Health–Education–Livelihood campuses. Use blockchain to track medicines. Promote mental health programs. Integrate AYUSH with modern care. Develop climate-resilient health centres. Expand Ayushman Bharat Health Accounts. Create women-led health councils in villages. |
UPSC MAINS PYQ-
Q.”Besides being a moral imperative of a Welfare State, a primary health structure is a necessary pre-condition for sustainable development.” Analyse.(2021)
UPSC Mains practice Question:
Q “Discuss the significance of civic engagement in improving health governance in India. Suggest measures to make community participation more meaningful and inclusive.”
SOURCE- THE HINDU
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