Critically examine how India’s public health schemes, including Ayushman Bharat – PMJAY and public-private partnerships, address equity and access. Discuss the limitations of downstream interventions and suggest reforms to strengthen upstream preventive healthcare.

Question

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Introduction

India’s public health initiatives aim to enhance equity and access in a diverse population. Schemes like Ayushman Bharat – PMJAY provide financial protection for hospitalisation, while public-private partnerships (PPPs) expand service delivery capacity. Together, they target affordability and availability of tertiary and secondary care for marginalized communities.

Key Dimensions

Equity and Access: PMJAY covers over 120 million families, reducing out-of-pocket expenditure. PPPs, such as state-level diagnostic and specialty hospitals, extend services to underserved regions.
Downstream Focus: Most interventions are hospital-centric, emphasising curative care. While life-saving, this approach does not prevent disease onset or address social determinants of health.
Limitations: Limited emphasis on nutrition, sanitation, early detection, and health literacy perpetuates inequities. Rural areas face workforce shortages despite scheme coverage.

Strengthening Upstream Interventions

Preventive Healthcare: Scale Health and Wellness Centres under Ayushman Bharat to provide screenings, immunisation, and NCD management.
Integrated Primary Care: Strengthen community health workers, telemedicine, and mobile health units to enhance early intervention.
Policy Reforms: Invest in health education, sanitation, and social determinants; incentivise research on public health outcomes; encourage outcome-linked funding for preventive care.

Conclusion

Balancing downstream curative schemes with upstream preventive strategies ensures sustainable equity, reduces healthcare burden, and fosters comprehensive public health in India.

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