Health systems in India

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Abstract

Health systems and polices have a critical role in determining the manner in which health services are delivered, utilized and affect health outcomes. ‘Health' being a state subject, despite the issuance of the guidelines by the central government, the final prerogative on implementation of the initiatives on newborn care lies with the states. This article briefly describes the public health structure in the country and traces the evolution of the major health programs and initiatives with a particular focus on newborn health.

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What explains regulatory failure? Analysing the architecture of health care regulation in two Indian states.

Kabir Sheikh, Prasanna S Saligram, Krishna Hort (2015)

Regulating health care is a pre-eminent policy challenge in many low- and middle-income countries (LMIC), particularly those with a strong private health sector. Yet, the regulatory approaches instituted in these countries have often been reported to be ineffective-India being exemplary. There is limited empirical research on the architecture and processes of health care regulation in LMIC that would explain these regulatory failures. We undertook a research study in two Indian states, with the aims of (1) mapping the organizations engaged with, and the written policies focused on health care regulation, (2) identifying gaps in the design and implementation of policies for health care regulation and (3) investigating underlying reasons for the identified gaps. We adopted a stepped research approach and applied a framework of basic regulatory functions for health care, to assess prevailing gaps in policy design and implementation. Qualitative research methods were employed including in-depth interviews with 32 representatives of regulatory organizations and document review. Several gaps in policy design were observed across both states, with a number of basic regulatory functions not underwritten in law, nor assigned to a regulatory organization to enact. In some instances the contents of regulatory policies had been weakened or diluted, rendering them less effective. Implementation gaps were also extensively reported in both states. Regulatory gaps were underpinned by human resource constraints, ambivalence in the roles of regulatory organizations, ineffective co-ordination between regulatory groups and extensive contestation of regulatory policies by private stakeholders. The findings are instructive that prevailing arrangements for health care regulation are ill equipped to enact several basic functions, and further that the performance of regulatory organizations is subject to pressures and distortions similar to those characterizing the wider health system. This suggests that attempts to strengthen health care regulation will be ineffectual unless underlying governance failures are addressed.

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Lumping and splitting: the health policy agenda in India.

Robert Fryatt, K. Rao, David H. Peters (2003)

India's health system was designed in a different era, when expectations of the public and private sectors were quite different. India's population is also undergoing transitions in the demographic, epidemiologic and social aspects of health. Disparities in life expectancy, disease, access to health care and protection from financial risks have increased. These factors are challenging the health system to respond in new ways. The old approach to national health policies and programmes is increasingly inappropriate. By analyzing inter- and intra-state differences in contexts and processes, we argue that the content of national health policy needs to be more diverse and accommodating to specific states and districts. More 'splitting' of India's health policy at the state level would better address their health problems, and would open the way to innovation and local accountability. States further along the health transition would be able to develop policies to deal with the emerging epidemic of non-communicable diseases and more appropriate health financing systems. States early in the transition would need to focus on improving the quality and access of essential public health services, and empowering communities to take more ownership. Better 'lumping' of policy issues at the central level is also needed, but not in ways that have been done in the past. The central government needs to focus on overcoming the large inequalities in health outcomes across India, tackle growing challenges to health such as the HIV epidemic, and provide the much needed leadership on systemic issues such as the development of systems for quality assurance and regulation of the private sector. It also needs to support and facilitate states and districts to develop critical capacities rather than directly manage programmes. As India develops a more diverse set of state health policies, there will be more opportunities to learn what works in different policy environments.

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Author and article information

Journal

Journal ID (nlm-ta): J Perinatol

Journal ID (iso-abbrev): J Perinatol

Title: Journal of Perinatology

Publisher: Nature Publishing Group

ISSN (Print): 0743-8346

ISSN (Electronic): 1476-5543

Publication date (Print): December 2016

Publication date (Electronic): 07 December 2016

Volume: 36

Issue: Suppl 3

Pages: S9-S12

Affiliations

[1 ]Indian Institute of Public Health (Delhi), Public Health Foundation of India , Gurgaon, India

[2 ]Saving Newborn Lives, Save the Children , India

[3 ]Department of Paediatrics, All India Institute of Medical Sciences , New Delhi, India

Author notes

[* ]Indian Institute of Public Health (Delhi), Public Health Foundation of India , Plot No 47, Sector-44 Institutional Area, Gurgaon 122002, India. E-mail: sanjay.zodpey@ 123456phfi.org

Article

Publisher Item ID: jp2016184

DOI: 10.1038/jp.2016.184

PMC ID: 5144115

PubMed ID: 27924110

SO-VID: 53099f0b-7429-455d-88ea-eec3f50d3019

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This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License. The images or other third party material in this article are included in the article's Creative Commons license, unless indicated otherwise in the credit line; if the material is not included under the Creative Commons license, users will need to obtain permission from the license holder to reproduce the material. To view a copy of this license, visit http://creativecommons.org/licenses/by-nc-nd/4.0/

Health systems in India

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Pediatric Pulse: Advancing Neonatal and Child Health

Most cited references 2

What explains regulatory failure? Analysing the architecture of health care regulation in two Indian states.

Lumping and splitting: the health policy agenda in India.

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