UPSC MAINS 2019: Healthcare’s Primary Problem

Healthcare’s Primary Problem

Topic: Healthcare’s Primary Problem

Topic in Syllabus: GS Paper 2: Indian Society – Health Issues

Healthcare’s Primary Problem


Why in news:

The deaths of 154 children in Bihar due to acute encephalitis syndrome (AES) has been linked to two factors:

  • Litchi consumption by starving children 
  • A long ongoing heat wave


Prevention of AES

AES is largely preventable both before and just after the onset of the disease and treatable with high chances of success on availability of medical intervention within 2-4 hours of symptoms. 

Therefore, the first signs of an outbreak must prompt strong prevention measures. 

These include:

  • A robust health education drive.
  • Replenishing primary health centres (PHCs) with essential supplies.
  • Extensive deployment of peripheral health workers (ASHA workers).
  • Ambulance services to facilitate rapid identification. 
  • Management of suspected cases.
  • Vacant doctor positions in PHCs must be urgently filled through deputation.
  • Short-term scaling-up of the Poshan Abhiyaan.
  • The supplementary nutrition programme which makes available hot, cooked meals for pre-school children at Anganwadis along with take home ration for mothers and distribution of glucose/ORS packets in risk households.

Nearly every one of these elements lies undermined in Bihar.


Crumbling healthcare in Bihar

  • In Bihar, one PHC caters to about 1 lakh people rather than the norm of 1 PHC per 30,000 people. Furthermore, it is critical for such a PHC, catering to more than three times the standard population size, to have at least two doctors. 
  • Three-fourths of the nearly 1,900 PHCs in Bihar have just one doctor each. 
  • Muzaffarpur has 103 PHCs (about 70 short of the ideal number) with 98 of them falling short of basic requirements outlined by the Health Management Information System. 
  • Bihar, one of the most populous States, had a doctor-population ratio of 1:17,685 in 2018, 60% higher than the national average, and with only 2% of the total MBBS seats in the country. 
  • There is also a one-fifth shortage of ASHA personnel, and nearly one-third of the sub-health centres have no health workers at all. 
  • While the State reels under the highest load of malnutrition in India, a study found that around 71% and 38% of funds meant for hot, cooked meals and take home ration, respectively, under the supplementary nutrition programme, were pilfered. 
  • Meals were served for just more than half the number of prescribed days, and only about half the number of beneficiaries on average actually got them.
  • Even those PHCs with adequate supplies remain underutilized. Perennial subscription to selective healthcare services by PHCs, like family planning and immunization, have cultivated the perception that PHCs are inept as centres of general healthcare. 
  • This leads patients either directly to apex government hospitals situated far away or to unqualified private providers. This results in a patient losing precious time in transit and landing up in a hospital in a critical and often irreversible stage of illness.


Way forward

  • Revamp primary health infrastructure.
  • The solution lies in building more functional PHCs and sub-health centers.
  • Scaling-up the cadres of ASHA workers.
  • Strict monitoring of nutrition programmes.
  • Addressing the maldistribution of doctors, medical colleges and vacancies.
  • The resultant robust primary care system can then be geared towards being more responsive to future outbreaks.
  • We should also bolster our technical capacity to better investigate the causes of such outbreaks and operationalise a concrete long-term strategy.
  • Decades of hospital-centric growth of health services have eroded faith in community-based healthcare. In these circumstances, even easily manageable illnesses increase demand for hospital services rather than PHCs.



  • Merely strengthening the tertiary care sector will be inefficient and ineffective. 
  • Primary healthcare should be the strong foundation of health development narrative.
  • There is need to work on inculcating confidence in community-based care.


Sample question:

In the context of the breakout of the acute encephalitis syndrome (AES) in Bihar, analyse the shortcomings of healthcare sector.

Healthcare's Primary Problem - Info graphic