Even though health, as a sector, does not appear in many places of the Indian Constitution, there are indirect and tacit references to health of the people and the role the state has to play in the development of health of the people. While the Union Government is responsible for inter-state migration; Inter-State quarantine, the state government is directly responsible for public health and sanitation, hospitals and dispensaries. Like other states, Public Healthcare forms an integral aspect of public policy of state government and state spends around 5% of state budget on health services.
Important Health Indicators:
Problem with Public Health Care in Rajasthan:
High out-of-pocket expenses on healthcare in Rajasthan
- In Rajasthan healthcare requires high out-of-pocket expenditure with about 75% of total expenses on healthcare being borne by individuals. This high out of pocket expenditure is also one of the causes of poverty and this often pushes families into poverty.
- Additionally, many poor rural families travel to urban centres for treatment – this only pushes up the cost of availing healthcare, as they must then pay for travel and stay in the urban location
- A bulk of government expense is on the tertiary sector, whereas a robust primary health centre could prevent diseases from progressing and offer timely and effective medical support.
- There is also urban skew in government spending on health – in 2016-17, while the total spend in urban areas was Rs 1,978.17 crore, it was Rs 1,991.99 for the rural areas – this despite the fact that at least 65% of the state’s population is rural.
Under budget & Under Utilization:
- Less than 2% of the state’s GDP is allocated to healthcare services, which is grossly inadequate.
- The share of health in the state budget is just about 5%; and even this allocated fund is often not used. In 2014-15, only 74% of the allocation was utilized.
- Even under the National Health Mission, despite its status of a mission, allocated budgets are seldom fully utilized.
Lack of Accountability:
- The dependence on private hospitals is not only leading to diversion of huge public funds into private hands but is also resulting in severe cases of exploitation and abuse of patients by the private healthcare providers, for which there is lack of accountability.
- There are also lack of mechanism to ensure accountability of hospitals and doctors towards quality service. Example, Rajasthan records highest rate of sterilization failures in the country.
- There have been cases of maternal and child deaths which highlighted various dimensions of negligence and insensitivity on the part of healthcare providers.
- Cases were highlighted wherein people had to go through tremendous hardships in seeking benefits of Bhamashah Swasthya Bima Yojana (BSBY) due to complicated eligibility criteria and how they were misled by private health facilities to squeeze more money out of their pockets.
Lack of Healthcare Infrastructure:
Steps taken by Government:
In order to achieve further improvements in health indicators, National Immunization Program is being implemented to protect pregnant women and children below one year age from Tetanus Toxoid (TT), Bacilli Chalmette Guerin (BCG), Diphtheria Pertussis Tetanus (DPT), cholera, etc.
The National Health Mission (NHM) is a national effort for ensuring provision of effective healthcare through a range of interventions at individual, household, community and critically at the health system levels. In the first phase, NRHM was started in 2005 and completed in 2012 and now in the second phase NHM is being implemented till year 2017. The mission focuses on rural as well as urban health therefore, National Rural Health Mission (NRHM) and National Urban Health Mission (NUHM) are being implemented as Sub-missions of National Health Mission (NHM).
Many schemes or new initiatives have been implemented by the Rajasthan Government to improve the health indicators in the state in past recent years. Some of the major schemes are as follows
- Mukhya Mantri Nishulk Dava Yojan
- Mukhya Mantri Nishulk Janch Yojana
- Rajasthan Janani Shishu Suraksha Yojna (RJSSY)
- Rashtriya Bal Swasthya Karykram
- Chief Minister’s BPL Jeevan Raksha Kosh scheme
- Janani Express
- National Mental Health Program
- Naya Savera (Swasthaya Jeevan Ki Aur) for Doda Post Users
- Dhanvantari 108 Toll free Ambulance Yojana
- Bhamashaha Swasthaya Bima Yojana.
- Aarogya Rajasthan
- The state government is preparing health data of people through Aarogya Rajasthan. Under this, the state has included data of 3.72 crore people online after a survey of 94.32 lakh families in rural Rajasthan.
Public Private Partnership (PPP) in Primary Health Care
In June 2015, Rajasthan Government decided to run PHC public-private partnership (PPP) mode. There were 2,082 PHCs operating in Rajasthan. In first phase, 90 out of these 2082 were handed over to be run in PPP mode. Selection of private partners was done through the open bidding system and private operators were asked provide doctors, paramedics and other staff, free OPD, and 24-hour emergency scheme among other things. Readmore
eInitiatives in Healthcare
In the last few years Information Technology in health sector has been a game changer in healthcare industry and is bound to continue as the industry strives to automate medical records, improve electronic reporting, simplify daily work flows and increase cost savings by streamlining work efforts.
- Integrated System for Monitoring of PCPNDT Act (IMPACT) Software provides the online form F for center registered to report to appropriate authority. All sonography centres in the state have been enrolled with the Medical, Health & Family Welfare department and details are available in the software. The web based Software IMPACT was launched on October 1, 2012 by the Medical Health & Family Welfare department. It provides online surveillance system of government for prevention of sex determination to save girl child.
- Pregnancy, Child Tracking & Health Services Management System (PCTS) is a online software used as an effective planning and management tool by Medical, Health & Family Welfare department, Government of Rajasthan. The system maintains online data of more than 13,000 government health institutions in the state.
- ASHA Soft is an online system which facilitates the health department, to capture beneficiary wise details of services given by ASHA to the community. It also provides online payment of ASHA to their bank accounts and calculation of total incentive given will be in accordance with the actual health services provided, which will help in strengthening of monitoring and management of physical & financial progress.
- Saghan Nirikshan Abhiyaan is an designed institution-wise check list to identify the gaps in the health services at the health institution. This initiative gives access to information anywhere and anytime, direct and effective monitoring of progress, better planning and decision making, identification of gaps in health facilities, infrastructure and also in identifying best health institutions.
- e-Aushadhi is a web-based application which deals with the management of stock of various drugs, sutures and surgical items required by different district drug warehouses of Rajasthan.
Providing quality health services to all citizens is the duty of the government for which national health policies have been drafted and must be implemented. The state government needs to develop complementary and alternative medicine centres, super specialty healthcare institutions to ensure qualitative delivery of healthcare at pocket-friendly cost. The government should also promote development of centers of excellence for medical care, investment of private sector in medical healthcare institutions and support units (diagnostic centers, blood banks and paramedical training institutions), and also take steps towards promotion of medical tourism.