ISSN (Print) - 0012-9976 | ISSN (Online) - 2349-8846

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Delhi’s Mohalla Clinics Hold the Potential to Significantly Improve Access to Quality Healthcare

In 2015, the Aam Aadmi Party-led Delhi government introduced “Aam Aadmi Mohalla Clinics” to provide affordable basic healthcare to marginalised sections of society at their “doorsteps.” This paper evaluates the effectiveness of the programme based on a survey of 493 respondents. We found that while AAMCs partially meet their stated objectives, several areas need urgent attention including lack of information about clinics, casteism by doctors and property owners, and availability of services.

Policy Complementarities in Achieving Universal Immunisation Coverage in India

The role of two policy pillars in achieving immunisation coverage of essential vaccines in India is examined by assessing the funds disbursed by the centre to the state governments under the Universal Immunisation Programme and the available physical health infrastructure in the states. It is found that funds by themselves are ineffective in improving vaccination coverage but are effective in conjunction with the available infrastructure. This finding has important implications for achieving full immunisation coverage, which stems from the sharing of responsibilities between the central and state governments under India’s federalised system of government.

Estimates of Health Insurance Coverage in India

Financing health expenditure through health insurance is currently gaining significance as a strong social policy in countries like India where public health facilities are still inadequate. An attempt to estimate the coverage of health insurance in India shows that the coverage is low and not uniform across states and union territories, despite the fact that several public-funded schemes focus on the below poverty line population. Of the various types of health insurance schemes, public-funded health insurance schemes have a dominant position. Moreover, the likelihood of health insurance coverage is relatively higher among specific social groups and in certain areas.

Invest More in Public Healthcare Facilities

Data from National Sample Surveys (71st round, 2014 and 75th round, 2017–18) show that there is a significant increase in the utilisation of public facilities for both outpatient and inpatient services, across empowered action group states and non-EAG states. As a result, there is a dramatic fall in the overall financial burden on patients who would have otherwise used services of private healthcare providers. In light of this evidence, this paper argues that it is prudent to invest more directly to strengthen public healthcare delivery system in India.

Impact of Natural Background Radiation on Health

High natural background radiation is a constant presence in the lives of those inhabiting some coastal regions of Kerala and Tamil Nadu. While there is agreement about the existence of radiation, some studies claim that it has no impact on the health of the population, while others disagree. There is a need to examine these findings critically, because of implications for public health, and to understand some of the technical reasons for why some papers appear to find no support for evidence (lack of statistical significance) of impact on health due to high levels of background radiation.

Emerging Governmentality and Biopolitics of COVID-19 in India

Measures like disciplining and quarantining are associated with the governments’ extraordinary powers during unprecedented times. In this context, the biopolitics of the ongoing COVID-19 pandemic is discussed. When the steps taken by the government to contain the spread of coronavirus are failing, we need new imageries to tackle the challenges that lie ahead of us.

Ayushman Bharat

The Pradhan Mantri Jan Arogya Yojana is an ambitious health insurance scheme that has been touted as an important tool to achieve universal health coverage. However, there is still no clarity regarding the financial implications of this scheme. Based on National Sample Survey data of 2004 and 2014 on hospitalisation rates and average medical expenditures, three alternate scenarios have been analysed based on different assumptions about these two parameters, to estimate the total costs of the programme. The results indicate a potentially high burden of the programme on the state and union government finances, especially if it is successful in covering all the intended beneficiaries.

Too Much Care

In the context of India where public expenditure on healthcare is low, the private sector plays an important role in delivering healthcare during childbirth. An analysis of the latest round of National Family Health Survey data to estimate the differential probability of caesarean sections in private medical facilities relative to government facilities, and focusing on unplanned C-sections, reveals that the probability of an unplanned C-section is 13.5–14 percentage points higher in the private sector. These results call for a critical assessment of the role of private sector in healthcare in the context of inadequate public provision, expanding private provision and weak governance structures.

Higher Disease Burden in India’s Elderly

The disease burden among the elderly population is significantly higher compared to the younger population, according to the data from the 75th round National Sample Survey, 2017–18, which increases their vulnerability during the COVID-19 pandemic. The footprint of elderly population in public facilities for inpatient and outpatient care has increased over the years. Financially, the elderly face far less burden in public facilities than in private facilities.

Birth Pangs

In June 2018, a small survey of the Pradhan Mantri Matru Vandana Yojana in two blocks of Jharkhand—Manika in Latehar district and Khunti in Khunti district—examined the status of the scheme and the problems faced by women at the time of pregnancy and delivery, such as health expenditure, inadequate nutrition, and loss of income. The findings call for better implementation of the scheme, as well as make a case for maternity benefits to be raised to a minimum of ₹6,000 per child for all pregnancies and not just for the first living child.

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