Beyond Insurance: Reimagining a People-Centric Public Health System for India

The Main Explanatory

Recent shifts in India's public health policy, particularly under the Ayushman Bharat umbrella, have moved the focus towards individual wellness and digital infrastructure. While these initiatives aim to modernise the health system, they have sparked a debate about whether they address the foundational challenges of access, affordability, and quality in public healthcare.

### What is the central tension in India's current health policy?

The core tension lies between two competing visions for achieving Universal Health Coverage (UHC). One vision prioritises strengthening the three-tiered public health system—Sub-Centres (SCs), Primary Health Centres (PHCs), and Community Health Centres (CHCs)—to ensure direct provisioning of care. The other, which has gained prominence, focuses on a publicly funded, insurance-based model to finance care, primarily in the private sector, coupled with a digital ecosystem to manage health information. The National Health Policy 2017 advocates for a 'progressively incremental' approach, but recent initiatives have been critiqued for heavily favouring the latter vision. Critics, such as Mathew George, Professor at the Central University of Kerala, argue that this shift risks neglecting the 'felt needs' of the population, such as access to affordable curative care, in favour of top-down policy priorities (Source: The Hindu, June 24, 2023).

### How have Health and Wellness Centres shifted the focus?

The Ayushman Bharat Health and Wellness Centres (HWCs) initiative, launched in 2018, was designed to transform 1,50,000 SCs and PHCs into comprehensive primary healthcare providers. The stated government objective was to move from selective to comprehensive primary care, including screening for non-communicable diseases, maternal and child health services, and diagnostics. However, a key criticism revolves around the implementation and its conceptual underpinnings. The mandatory renaming of all grassroots institutions by adding 'Health and Wellness Centre' as a prefix has, according to some public health experts, created ambiguity about their specific roles within the district health system.