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Public Health in India: Gaps in Intent, Policy, and Practice

This Issue Brief is an attempt to understand the challenges before the health system in India and why these challenges persist. The year 2016 and 2017 in particular witnessed a series of tragedies so horrendous and widespread that they brought to light the deplorable state of the public health system in India. It was expected that some lessons will be drawn from the public health crisis in 2016, and that the year 2017 would fare better. However, the incidents repeated themselves in different parts of the country.

In 2016, a poor farmer in Odisha was forced to carry his wife’s corpse many miles in the absence of a support system. This year witnessed a similar incident in Uttar Pradesh. Likewise, 2016 saw the outbreak of chikungunya in Delhi and this year dengue and chikungunya infection broke out in Tamil Nadu and Kerala followed by the death of approximately 77 children due to encephalitis in Gorakhpur district of Uttar Pradesh in August 2017. Though a public health system cannot be refurbished in a time span of one year, these public health emergencies establish the chronic nature of ailments affecting the system.

Various studies have found that the Indian health system is besieged by inadequate infrastructure, paucity of skilled human resources, inadequate drug and medical supply, lack of preparedness, all of these further burdened by an increase in communicable, non-communicable, and vector borne diseases. It is a further worry that at a time when the public health system is already in a bad shape and we have humongous Sustainable Development Goals (SDGs) to achieve, the government is withdrawing from providing health services and encouraging the private sector to play a greater role.

A glaring feature of public health delivery today is the government’s unwillingness to increase funding and prioritise public health. Increasing cost of medication, high out-of- pocket expenditure, and corruption in the health system have adversely affected public health and have combined to cripple the public health sector .

In order to better understand the Union government’s approach to public health, the Issue Brief views the above underscored challenges against the gap between the Draft National Health Policy of 2015 and the final National Health Policy of 2017 on the one hand, and the 2015 policy, and the Union Budget 2017-18 on the other.

The Issue Brief finally makes a set of recommendations to plug the gaps in public health delivery towards fulfilling the SDGs expected to be achieved over 15 years.

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