1) A weak primary healthcare sector-
In 2015, there was one government hospital bed for every 1,833 people compared with 2,336 persons a decade earlier but its not uniformally distributed. For instance, there is one government hospital bed for every 614 people in Goa compared with one every 8,789 people in Bihar.
2) Unequally distributed skilled human resources-
In community health centres in rural areas of many states, ranging from Gujarat to West Bengal, the shortfall of specialists exceeds 80%.
3) Large unregulated private sector-
The National Sample Survey Office (NSSO) numbers show a decrease in the use of public hospitals over the past two decades—only 32% of urban Indians use them now, compared with 43% in 1995-96.
Moreover, “the many new institutions set up in the past decade… encouraged by commercial incentives, have often fuelled corrupt practices and failed to offer quality education”,
4) Low public spending on health-
Even though real state expenditure on health has increased by 7% annually in recent years, central government expenditure has plateaued. Economically weaker states are particularly susceptible to low public health investments.
The 14th finance commission recommendations, which will transfer a greater share of central taxes to states, offers an opportunity for the latter to increase investments in health.
5) Fragmented health information systems-
Data is incomplete (in many cases it excludes the private sector) and many a time, it’s duplicated.
6) Weak governance and accountability-
“In the past 5 years, the government has introduced several new laws to strengthen governance of the health system, but many of these laws have not been widely implemented,” said Lancet. In some instances, the “scope of (some) regulations is still unclear, and there are fears that these laws have hindered public health trials led by non-commercial entities”.
“At the heart of these constraints is the apparent unwillingness on the part of the state to prioritize health as a fundamental public good, central to India’s developmental aspirations, on par with education. Put simply, there is no clear ownership of the idea of universal health coverage within the government,”