According to the article published in January 2024 in the International Journal of Humanities and Education Research, subsequent to the Indian government’s launch of the National Rural Health Mission (NRHM) in 2005, a study is based on qualitative data from focus group discussions conducted in three rural districts in Bihar and Uttar Pradesh, two high-focus states of the NRHM in northern India, in 2009/2010. The study population consists of female micro-credit self-help group members and their male household heads.
A directed content analysis and use a theoretical framework to differentiate between physical, financial and cultural access to care is applied. The study population distinguishes between “home treatment” (informal self-care), “local treatment” (formally unqualified care) and “outside treatment” (formally qualified care).
Because of their proximity, flexible payment options and familiarity with patients’ belief systems, among other things, local NDAPs are physically, financially, and culturally accessible. They are usually the first contact points for patients before turning to qualified practitioners, treat minor illnesses, first aid, provide first relief, refer patients to other providers, and administer formally prescribed treatments.
These findings are similar for all three other study sites and reinforce recent findings from southern and eastern India. Despite these efforts, recent evidence shows that the rural poor continue to primarily consult private non-degree allopathic practitioners (NDAPs) for acute illness episodes. On exploring this methodology, the poor understanding and utilization of the rural health system deviates from governmental ideas.
Because of their embeddedness in the community, private NDAPs are the most accessible medical providers and first contact points for acute illness episodes. Thus, they de facto fulfill the role envisaged by the Indian government for accredited social health activists introduced as part of the NRHM. It is concluded that instead of trying to replace NDAPs with public initiatives, the Indian government should regulate, qualify, and integrate them as part of the existing public health care system. This way, India can improve the rural poor’s access to formally qualified practitioners.
Considering that the private sector is the major player in healthcare service delivery, there have been many programs aiming to harness private expertise to provide public healthcare services. The latest is the new nationwide scheme proposed which accredits private providers to deliver services reimbursable by the Government. In an ideal world, this should result in the improvement of coverage levels, but does it represent a transfer of responsibility and an acknowledgment of the deficiencies of the public health system?
Affordability or the cost of healthcare:
As trainers and educators in public health, how are we equipping our trainees to deliver a health service in the manner required, at the place where it is needed, and at the time when it is essential? It is time for a policy on health human power to be articulated, which must outline measures to ensure that the last Indian is taken care of by a sensitive, trained, and competent healthcare worker.
Affordability or the cost of healthcare: Quite simply, how costly is healthcare in India, and more importantly, how many can afford the cost of healthcare? It is common knowledge that the private sector is the dominant player in the healthcare arena in India. Almost 75% of healthcare expenditure comes from the pockets of households, and catastrophic healthcare cost is an important cause of impoverishment. Added to the problem is the lack of regulation in the private sector and the consequent variation in quality and costs of services.
The public sector offers healthcare at low or no cost but is perceived as being unreliable, of indifferent quality and generally is not the first choice, unless one cannot afford private care. The solutions to the problem of affordability of healthcare lie in local and national initiatives. Nationally, the Government expenditure on health must urgently be scaled up, from <2% currently to at least 5%–6% of the gross domestic product in the short term.
This will translate into the much-needed infrastructure boost in the rural and marginalized areas and hopefully to better availability of healthcare– services, infrastructure, and personnel. The much-awaited national health insurance program should be carefully rolled out, ensuring that the smallest member of the target population is enrolled and understands what exactly the scheme means to her.
Locally, a consciousness of cost needs to be built into the healthcare sector, from the smallest to the highest level. Wasteful expenditure, options that demand high spending, and unnecessary use of tests, and procedures should be avoided. The average medical student is not exposed to issues of cost of care during the course. Exposing young minds to issues of economics of healthcare will hopefully bring in a realization of the enormity of the situation, and the need to address it in whatever way possible. Accountability or the lack of it: Being accountable has been defined as the procedures and processes by which one party justifies and takes responsibility for its activities.
