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	<title>Public health system in India - Revision history</title>
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		<summary type="html">&lt;p&gt;Created a new article&lt;/p&gt;
&lt;p&gt;&lt;b&gt;New page&lt;/b&gt;&lt;/p&gt;&lt;div&gt;{{Short description|none}} &amp;lt;!-- This short description is INTENTIONALLY &amp;quot;none&amp;quot; - please see WP:SDNONE before you consider changing it! --&amp;gt;&lt;br /&gt;
{{Use dmy dates|date=December 2015}}&lt;br /&gt;
{{Use Indian English|date=December 2015}}&lt;br /&gt;
&lt;br /&gt;
The public healthcare system in [[India]] evolved due to a number of influences since 1947, including [[United Kingdom|British]] influence from the colonial period.&amp;lt;ref name=healthsystemsinindia&amp;gt;{{cite journal|last1=Chokshi|first1=M|last2=Patil|first2=B|last3=Khanna|first3=R|last4=Neogi|first4=S|last5=Sharma|first5=J|last6=Paul|first6=V|last7=Zodpey|first7=S|title=Health systems in India|journal=Journal of Perinatology|date=December 2016|volume=36|issue=Suppl 3|pages=S9–S12|doi=10.1038/jp.2016.184|pmid=27924110|pmc=5144115}}&amp;lt;/ref&amp;gt; The need for an efficient and effective &amp;#039;&amp;#039;&amp;#039;public health system in India&amp;#039;&amp;#039;&amp;#039; is large. Public health system across nations is a conglomeration of all organized activities that prevent disease, prolong life and promote health and efficiency of its people. Indian healthcare system has been historically dominated by provisioning of medical care and neglected public health.&amp;lt;ref name=&amp;quot;publichealthinindia&amp;quot; /&amp;gt;  11.9% of all [[maternal deaths]] and 18% of all [[infant mortality]] in the world occurs in India, ranking it the highest in the world.&amp;lt;ref&amp;gt;{{Cite web|url=https://data.worldbank.org/indicator/SH.MMR.DTHS?most_recent_value_desc=true|title = Number of maternal deaths &amp;amp;#124; Data}}&amp;lt;/ref&amp;gt;&amp;lt;ref&amp;gt;{{Cite web|url=https://data.worldbank.org/indicator/SH.DTH.IMRT?most_recent_value_desc=true|title = Number of infant deaths &amp;amp;#124; Data}}&amp;lt;/ref&amp;gt; 36.6 out of 1000 children are dead by the time they reach the age of 5.&amp;lt;ref&amp;gt;{{Cite web|url=https://data.unicef.org/topic/child-survival/under-five-mortality/|title=Child Mortality}}&amp;lt;/ref&amp;gt; 62% of children are immunized.&amp;lt;ref&amp;gt;{{cite web | url=https://niti.gov.in/content/immunisation | title=&amp;amp;#124; NITI Aayog }}&amp;lt;/ref&amp;gt; Communicable disease is the cause of death for 53% of all deaths in India.&amp;lt;ref name= &amp;quot;healthcareandequityinindia&amp;quot;&amp;gt;{{cite journal|last1=Balarajan|first1=Yarlini|last2=Selvaraj|first2=S|last3=Subramanian|first3=S|title=Health care and equity in India|journal=Lancet|date=11 January 2011|volume=377|issue=9764|pages=505–515|pmc=3093249|pmid=21227492|doi=10.1016/S0140-6736(10)61894-6}}&amp;lt;/ref&amp;gt;&lt;br /&gt;
&lt;br /&gt;
Public health initiatives that affect people in all states, such as the [[National Health Mission]], [[Ayushman Bharat Yojana|Ayushman Bharat]], National Mental Health Program, are instilled by the Union [[Ministry of Health and Family Welfare]].&amp;lt;ref name=&amp;quot;healthsystemsinindia&amp;quot;/&amp;gt; There are multiple systems set up in rural and urban areas of India including Primary Health Centres, Community Health Centres, Sub Centres, and Government Hospitals. These programmes must follow the standards set by Indian Public Health Standards documents that are revised when needed.&amp;lt;ref name=twelfthfiveyearplan&amp;gt;{{cite book|title=Twelfth Five Year Plan (2012-17)|publisher=Planning Commission, Government of India, New Delhi|edition=Vol-III|chapter-url=http://planningcommission.nic.in/plans/planrel/fiveyr/12th/pdf/12fyp_vol3.pdf|chapter=20}}&amp;lt;/ref&amp;gt;&lt;br /&gt;
&lt;br /&gt;
==History==&lt;br /&gt;
Public health systems in the colonial period were focused on health care for British citizens who were living in India. The period saw [[research institutes]], public health legislation, and sanitation departments, although only 3% of Indian households had toilets at this time.&amp;lt;ref name= publichealthinindia&amp;gt;{{cite journal|last1=Gupta|first1=Monica|title=Public Health in India: Dangerous Neglect|journal=Economic and Political Weekly|date=December 2005|volume=40|issue=49|pages=5159–5165|jstor= 4417485}}&amp;lt;/ref&amp;gt; Annual health reports were released and the prevention of contagious disease outbreaks was stressed. At the end of the colonial period, death rates from [[infectious diseases]] such as [[cholera]] had fallen to a low, although other diseases were still rampant.&amp;lt;ref name=&amp;quot;publichealthinindia&amp;quot;/&amp;gt;&lt;br /&gt;
&lt;br /&gt;
In modern-day India, the spread of communicable diseases is under better control and now non-communicable diseases, mostly like [[cardiovascular diseases]], are major killers.&amp;lt;ref name= &amp;quot;publichealthinindia&amp;quot;/&amp;gt; Health care reform was prioritized in the 1946 [[Bhore Committee]] Report which suggested the implementation of a health care system that was financed at least in part by the Indian government.&amp;lt;ref name=&amp;quot;healthsystemsinindia&amp;quot;/&amp;gt; In 1983 the first National Health Policy (NHP) of India was created with the goals of establishing a system with primary-care facilities and a referral system. In 2002, the updated NHP focused on improving the practicality and reach of the system as well as incorporating private and public [[clinics]] into the health sphere.&amp;lt;ref name=&amp;quot;healthsystemsinindia&amp;quot;/&amp;gt; In the context of universal health coverage, the recent policy focus in India, there is an attempt to ensure that every citizen should have adequate access to curative care without any financial hardships. Equally relevant is the acknowledgement of social determinants of health as an important determinant of population health and the need to have a public health cadre within the existing health care system. This call for a need to distinguish&amp;lt;ref&amp;gt;{{Cite journal|last=George|first=Mathew|date=2014-09-11|title=Commentary: Viewpoint: Re-instating a &amp;#039;public health&amp;#039; system under universal health care in India|journal=Journal of Public Health Policy|volume=36|issue=1|pages=15–23|doi=10.1057/jphp.2014.37|pmid=25209538|s2cid=42303783|issn=0197-5897}}&amp;lt;/ref&amp;gt; between &amp;#039;Public health&amp;#039; system and &amp;#039;Public&amp;#039; sector health care system as the latter uses public to indicate the primary role of government and not necessarily as population as used in public health.{{cn|date=May 2023}}&lt;br /&gt;
&lt;br /&gt;
Public health funding has been directed to helping the middle and upper classes, as it targets creating more health professional jobs, expanding research institutions, and improving training. This creates unequal access to health care for the lower classes who do not receive the benefits of this funding.&amp;lt;ref name= &amp;quot;publichealthinindia&amp;quot;/&amp;gt; Today, states pay for about 75% of the public healthcare system but insufficient state spending neglects the public health system in India.&amp;lt;ref name= betterhealthsystemsforIndiaspoor&amp;gt;{{cite book|last1=Peters|first1=David|title=Better Health Systems for India&amp;#039;s Poor: Findings, Analysis, and Options|chapter-url=https://archive.org/details/betterhealthsyst0000unse|chapter-url-access=registration|date=Jan 1, 2002|publisher=World Bank Publications|chapter=2}}&amp;lt;/ref&amp;gt; This results in the Out-of-pocket health expenditure by households comprising 60.6% of the total health expenditure of India.&amp;lt;ref&amp;gt;http://nhsrcindia.org/sites/default/files/NHA%20Estimates%20Report%20-%20November%202018.pdf {{Bare URL PDF|date=March 2022}}&amp;lt;/ref&amp;gt;&amp;lt;ref&amp;gt;{{Cite web|url=http://nhsrcindia.org/sites/default/files/NHA%20Estimates%20Report%20-%20November%202018.pdf|title=National Health Accounts - Estimates for India -Financial Year 2015-16|website=nhsrcindia.org}}&amp;lt;/ref&amp;gt; Thus, a large number of households are pushed below poverty line every year.{{cn|date=May 2023}}&lt;br /&gt;
&lt;br /&gt;
==Facilities==&lt;br /&gt;
&lt;br /&gt;
The healthcare system is organised into primary, secondary, and tertiary levels. At the primary level are Sub Centres and [[Primary Health Centre (India)|Primary Health Centres]] (PHCs). At the secondary level there are Community Health Centres (CHCs) and smaller Sub-District hospitals. Finally, the top level of public care provided by the government is the tertiary level, which consists of Medical Colleges and District/General Hospitals.&amp;lt;ref name=&amp;quot;healthsystemsinindia&amp;quot;/&amp;gt; The number of PHCs, CHCs, Sub Centres, and District Hospitals has increased in the past six years, although not all of them are up to the standards set by Indian Public Health Standards.&amp;lt;ref name=&amp;quot;twelfthfiveyearplan&amp;quot;/&amp;gt;&lt;br /&gt;
&lt;br /&gt;
===Sub Centres===&lt;br /&gt;
A Sub Centre is designed to serve extremely rural areas with the expenses fully covered by the national government. Mandates require health staff to be at least two workers (male and female) to serve a population of 5000 people (or 3000 in a remote or hilly areas). Sub Centres also work to educate rural people about healthy habits for a more long-term impact.&amp;lt;ref name=&amp;quot;healthsystemsinindia&amp;quot;/&amp;gt;&lt;br /&gt;
&lt;br /&gt;
===Primary Health Centres===&lt;br /&gt;
{{Main|Primary Health Centre (India)|l1 = Primary Health Centre (PHC)}}&lt;br /&gt;
Primary Health Centres exist in more developed rural areas of 30,000 or more (20,000 in remote areas) and serve as larger health clinics staffed with doctors and paramedics. Patients can be referred from local sub centres to PHCs for more complex cases.&amp;lt;ref name=&amp;quot;healthsystemsinindia&amp;quot;/&amp;gt; A major difference from Sub Centres is that state governments fund PHCs, not the national government. PHCs also function to improve health education with a larger emphasis on preventative measures.&amp;lt;ref name=&amp;quot;healthsystemsinindia&amp;quot;/&amp;gt;&lt;br /&gt;
&lt;br /&gt;
===Community Health Centres===&lt;br /&gt;
A Community Health Centre is also funded by state governments and accepts patients referred from Primary Health Centres. It serves 120,000 people in urban areas or 80,000 people in remote areas.&amp;lt;ref name=&amp;quot;healthsystemsinindia&amp;quot;/&amp;gt; Patients from these agencies can be transferred to general hospitals for further treatments. Thus, CHC&amp;#039;s are also first referral units, or FRUs, which are required to have obstetric care, new born/childcare, and blood storage capacities at all hours everyday of the week.&amp;lt;ref name=&amp;quot;healthsystemsinindia&amp;quot;/&amp;gt;&lt;br /&gt;
===Sub-District Hospitals/Taluk Hospitals===&lt;br /&gt;
Sub District/Sub Divisional/Taluk Hospitals are located in sub-district headquarters and provide more specialized medical services than community health centers. Taluk hospitals are located in taluk headquarters and provide more specialized medical services than community health centers.Taluk Hospital is a secondary healthcare center located in the administrative headquarters of a taluk (Tehsil). Taluk hospitals provide basic medical services to the people of the local community. They have departments for general medicine, pediatrics, obstetrics and gynecology, dermatology, ophthalmology, dentistry, and psychiatry. Taluk hospitals also have a laboratory and a pharmacy that provide diagnostic and treatment services to patients. The hospital has an emergency department that operates 24 hours a day, providing immediate medical attention to patients who require urgent medical care. Taluk Hospitals are set up either by upgrading the existing Community Health Centre (CHCs).  They are referred to as Sub-district (sub-divisional) hospital for the purpose of standardisation under the revised guidelines of Indian Public Health Standards ([[IPHS]]).  Taluk Hospitals are below the district and above the block level CHCs. Taluk Hospital serves as a vital connection between the SC (Sub-Centre), PHC (Public Health Centre), CHC (Community Health Centre), and District Hospital on one end. It reduces the workload at the district hospital and cuts travel time for patients in need of emergency care. Sub District hospitals are below the district and above the block level (CHC) hospitals and act&lt;br /&gt;
as Referral Units for the Tehsil/Taluk/Block population in which they are geographically located.{{cn|date=May 2023}}&lt;br /&gt;
&lt;br /&gt;
===District Hospitals===&lt;br /&gt;
District Hospitals are the final referral centres for the primary and secondary levels of the public health system. It is expected that at least one hospital is in each district of India, although in 2010 it was recorded that only 605 hospitals exist when there are 640 districts.&amp;lt;ref name= guidelinesfordistricthospitals&amp;gt;{{cite journal|title=Guidelines for District Hospitals|journal=Indian Public Health Standards|date=2012|url=http://www.nhm.gov.in/images/pdf/guidelines/iphs/iphs-revised-guidlines-2012/district-hospital.pdf|access-date=9 March 2018|publisher=Ministry of Health and Family Welfare, Government of India}}&amp;lt;/ref&amp;gt; There are normally anywhere between 75 and 500 beds, depending on population demand. These district hospitals often lack modern equipment and relations with local blood banks.&amp;lt;ref name= &amp;quot;guidelinesfordistricthospitals&amp;quot;/&amp;gt;&lt;br /&gt;
&lt;br /&gt;
===Medical Colleges and Research Institutions===&lt;br /&gt;
[[All India Institutes of Medical Sciences]] is owned and controlled by the central government. These are referral hospitals with specialized facilities. All India Institutes presently functional are AIIMS [[New Delhi]],  [[Bhopal]],&amp;lt;ref&amp;gt;[http://aiimsbhopal.edu.in/ AIIMS Bhopal.]&amp;lt;/ref&amp;gt; AIIMS Bhubaneshwar, AIIMS [[Jodhpur]], AIIMS [[Raipur]], AIIMS Patna and AIIMS [[Rishikesh|Rishiksh]]. A [[Regional Cancer Centre]] is a cancer care hospital and research institute controlled jointly by the central and the respective state governments. Government Medical Colleges are owned and controlled by the respective state governments and also function as referral hospitals.{{cn|date=May 2023}}&lt;br /&gt;
&lt;br /&gt;
==Government Public Health initiatives==&lt;br /&gt;
&lt;br /&gt;
In 2006, the [[Public Health Foundation of India]] was started by the Prime Minister of India as both a private and public initiative. The goal of this organisation is to incorporate more public health policies and diverse professionals into web the healthcare sphere. It also collaborates with international public health organisations to gather more knowledge and direct discussions around needs and improvements to the current system.&amp;lt;ref name=publichealthfoundationofindia&amp;gt;{{cite journal|last1=Reddy|first1=K|last2=Sivaramakrishnan|first2=Kavita|title=Unmet National Health Needs: Visions of Public Health Foundation of India|journal=Economic and Political Weekly|date=16 September 2016|volume=41|issue=37|pages=3927–3933|jstor=4418695}}&amp;lt;/ref&amp;gt; Oftentimes officials in policy making positions have a gap in their education about public health, and [[Master of Public Health|MPH]] and [[PhD]] programs in public health are lacking in their number of students and resources. The Public Health Foundation aims to further these programs and educate more people in this field. The research discovered would be made transparent to the Indian public at large, so that the entire nation is aware of health standards in the country.&amp;lt;ref name=publichealthfoundationofindia/&amp;gt;&lt;br /&gt;
&lt;br /&gt;
=== Community Health Workers ===&lt;br /&gt;
The Indian government first began to implement community health worker programs in 1977.&amp;lt;ref name=&amp;quot;:11&amp;quot;&amp;gt;{{Cite journal|last=Leslie|first=Charlie|date=October 1989|title=India&amp;#039;s Community Health Worker Scheme: A Sociological Analysis|journal=Ancient Science of Life|volume=2|pages=40–53}}&amp;lt;/ref&amp;gt; Community health workers provide advice and support to other women in their community. Sometimes referred to as &amp;#039;&amp;#039;sakhis&amp;#039;&amp;#039;, these women capitalize on their familiarity with the community to gain credibility and promote public health measures, usually by leading participatory groups.&amp;lt;ref name=&amp;quot;:8&amp;quot;&amp;gt;{{Cite journal|last1=Osrin|first1=David|last2=Vaidya|first2=Leena|last3=Porel|first3=Maya|last4=Patil|first4=Sarita|last5=More|first5=Neena Shah|last6=Alcock|first6=Glyn A.|date=2009-12-01|title=Community-based health programmes: role perceptions and experiences of female peer facilitators in Mumbai&amp;#039;s urban slums|journal=Health Education Research|language=en|volume=24|issue=6|pages=957–966|doi=10.1093/her/cyp038|pmid=19651641|pmc=2777946|issn=0268-1153}}&amp;lt;/ref&amp;gt; Community health workers also function to mediate between modern allopathic medicine and traditional indigenous forms of healing,&amp;lt;ref name=&amp;quot;:11&amp;quot; /&amp;gt; such as by tailoring allopathic health recommendations to include and legitimize traditional beliefs.&amp;lt;ref name=&amp;quot;:12&amp;quot;&amp;gt;{{Cite journal|last=Mishra|first=Arima|date=2014|title=&amp;#039;Trust and teamwork matter&amp;#039;: Community health workers&amp;#039; experiences in integrated service delivery in India|journal=Global Public Health|volume=9|issue=8|pages=960–974|doi=10.1080/17441692.2014.934877|pmid=25025872|pmc=4166967}}&amp;lt;/ref&amp;gt; Community health workers closely cooperate with each other and with other types of health workers (such as auxiliary nurse midwives) to encourage care utilization and deliver health services.&amp;lt;ref name=&amp;quot;:12&amp;quot; /&amp;gt; Currently, India&amp;#039;s largest community health worker program, started in 2005 and now subsumed in the National Health Mission, consists of nearly one million [[Accredited Social Health Activist]], a ratio of one for every 1000 people in rural villages and marginalized urban communities.&amp;lt;ref name=&amp;quot;:4&amp;quot;&amp;gt;{{Cite journal| last1=Ved|first1=R.|last2=Scott|first2=K.|last3=Gupta|first3=G.|last4=Ummer|first4=O.|last5=Singh|first5=S.| last6=Srivastava|first6=A.|last7=George|first7=A. S.|date=2019-01-08|title=How are gender inequalities facing India&amp;#039;s one million ASHAs being addressed? Policy origins and adaptations for the world&amp;#039;s largest all-female community health worker programme|journal=Human Resources for Health|volume=17|issue=1|pages=3|doi=10.1186/s12960-018-0338-0|issn=1478-4491|pmc=6323796|pmid=30616656}}&amp;lt;/ref&amp;gt;&lt;br /&gt;
&lt;br /&gt;
Community health workers and participatory groups have been shown to change health behaviors&amp;lt;ref name=&amp;quot;:4&amp;quot; /&amp;gt; and impact health outcomes such as neonatal mortality.&amp;lt;ref name=&amp;quot;:3&amp;quot;&amp;gt;{{Cite journal|last1=Rath|first1=Suchitra|last2=Nair|first2=Nirmala|last3=Tripathy|first3=Prasanta K.|last4=Barnett|first4=Sarah|last5=Rath|first5=Shibanand|last6=Mahapatra|first6=Rajendra|last7=Gope|first7=Rajkumar|last8=Bajpai|first8=Aparna|last9=Sinha|first9=Rajesh|date=2010-10-22|title=Explaining the impact of a women&amp;#039;s group led community mobilisation intervention on maternal and newborn health outcomes: the Ekjut trial process evaluation|journal=BMC International Health and Human Rights|volume=10|issue=1|pages=25|doi=10.1186/1472-698X-10-25|issn=1472-698X|pmc=2987759|pmid=20969787}}&amp;lt;/ref&amp;gt; Factors for these positive changes include active inclusion and recruitment of a large portion of women in the community, engagement and participation during skill development, and involvement of the community beyond group participation.&amp;lt;ref name=&amp;quot;:3&amp;quot; /&amp;gt; Community health workers may also serve as community leaders and change-makers by empowering women and demanding policy action to address health inequities.&amp;lt;ref name=&amp;quot;:13&amp;quot;&amp;gt;{{Cite journal|last1=Schneider|first1=Helen|last2=Nandi|first2=Sulakshana|date=2014-09-01|title=Addressing the social determinants of health: a case study from the Mitanin (community health worker) programme in India|journal=Health Policy and Planning|language=en|volume=29|issue=suppl_2|pages=ii71–ii81|doi=10.1093/heapol/czu074|issn=0268-1080|pmc=4202921|pmid=25274643}}&amp;lt;/ref&amp;gt; Addressing these social determinants of health has a direct impact on healthcare utilization.&amp;lt;ref name=&amp;quot;:13&amp;quot; /&amp;gt; For example, empowered women are less likely to face health problems because they are more likely to be aware of problems with their health and therefore more likely to seek care to address these problems.&amp;lt;ref name=&amp;quot;:9&amp;quot;&amp;gt;{{Cite journal|last1=Davis|first1=Lwendo Moonzwe|last2=Schensul|first2=Stephen L.|last3=Schensul|first3=Jean J.|last4=Verma|first4=Ravi|last5=Nastasi|first5=Bonnie K.|last6=Singh|first6=Rajendra|date=2014|title=Women&amp;#039;s empowerment and its differential impact on health in low income communities in Mumbai, India|journal=Global Public Health|volume=9|issue=5|pages=481–494|doi=10.1080/17441692.2014.904919|issn=1744-1692|pmc=4624628|pmid=24766149}}&amp;lt;/ref&amp;gt;&amp;lt;ref name=&amp;quot;:10&amp;quot;&amp;gt;{{Cite journal|last=Sharma|first=Aradhana|date=2006-01-01|title=Crossbreeding Institutions, Breeding Struggle: Women&amp;#039;s Employment, Neoliberal Governmentality, and State (Re)Formation in India|url=https://wesscholar.wesleyan.edu/div2facpubs/40|journal=Cultural Anthropology|volume=21|issue=1|doi=10.1525/can.2006.21.1.60}}&amp;lt;/ref&amp;gt;&lt;br /&gt;
&lt;br /&gt;
This grassroots intervention strategy often involves partnerships with local hospitals or government-organized non-governmental organizations (GONGOs),&amp;lt;ref name=&amp;quot;:10&amp;quot; /&amp;gt; who train female volunteers from the community and help organize participatory groups.&amp;lt;ref name=&amp;quot;:4&amp;quot; /&amp;gt; Though demonstrated to be effective, community health worker programs can be hampered by a lack of monitoring and accountability as a result of governmental decentralization.&amp;lt;ref&amp;gt;{{Cite journal|last=Singh|first=Nirvikar|date=2008|title=Decentralization and Public Delivery of Health Care Services in India|url=https://mpra.ub.uni-muenchen.de/7869/1/MPRA_paper_7869.pdf|journal=Health Affairs|volume=27|issue=4|pages=991–1001|doi=10.1377/hlthaff.27.4.991|pmid=18607032}}&amp;lt;/ref&amp;gt; Community health workers are not government employees but rather volunteers that state governments are responsible for training and financially incentivizing.&amp;lt;ref name=&amp;quot;:4&amp;quot; /&amp;gt; Health workers may also lack a sufficient understanding of the public health measure they are trying to promote due to inadequate training and resources.&amp;lt;ref name=&amp;quot;:11&amp;quot; /&amp;gt;&lt;br /&gt;
&lt;br /&gt;
==Drawbacks==&lt;br /&gt;
&lt;br /&gt;
Drawbacks to India&amp;#039;s healthcare system today include low quality care, [[corruption]], unhappiness with the system, a lack of accountability, unethical care, overcrowding of clinics, poor cooperation between public and private spheres, barriers of access to services and medicines, lack of [[public health]] knowledge, and low cost factor.&amp;lt;ref name=&amp;quot;twelfthfiveyearplan&amp;quot;/&amp;gt;&amp;lt;ref name= understandinggovernmentfailureinpublichealthservices&amp;gt;{{cite journal|last1=Hammer|first1=Jeffrey|last2=Aiyar|first2=Yamini|last3=Samji|first3=Salimah|title=Understanding Government Failure in Public Health Services|journal=Economic and Political Weekly|date=6 October 2017|volume=42|issue=40|pages=4049–4057|jstor= 40276648}}&amp;lt;/ref&amp;gt; These drawbacks push wealthier Indians to use the private healthcare system, which is less accessible to low-income families, creating unequal medical treatment between classes.doctors are reluctant to practice in rural areas.{{cn|date=July 2023}}&lt;br /&gt;
&lt;br /&gt;
===Low quality care===&lt;br /&gt;
&lt;br /&gt;
Low quality care is prevalent due to misdiagnosis, under trained health professionals, and the prescription of incorrect medicines. A study discovered a doctor in a PHC in [[Delhi]] who prescribed the wrong treatment method 50% of the time.&amp;lt;ref name=&amp;quot;understandinggovernmentfailureinpublichealthservices&amp;quot;/&amp;gt; Indians in rural areas where this problem is rampant are prevented from improving their health situation.&amp;lt;ref name=&amp;quot;healthcareandequityinindia&amp;quot;/&amp;gt; Enforcement and revision of the regulations set by the Union Ministry of Health and Family Welfare IPHS is also not strict. The [[12th Five-Year Plan (India)]] dictates a need to improve enforcement and institutionalize treatment methods across all clinics in the nation in order to increase the quality of care.&amp;lt;ref name=&amp;quot;twelfthfiveyearplan&amp;quot;/&amp;gt; There is also a lack of accountability across both private and public clinics in India, although public doctors feel less responsibility to treat their patients effectively than do doctors in private clinics. Impolite interactions from the clinic staff may lead to less effective procedures.&amp;lt;ref name=&amp;quot;understandinggovernmentfailureinpublichealthservices&amp;quot;/&amp;gt;&lt;br /&gt;
&lt;br /&gt;
=== Corruption ===&lt;br /&gt;
Healthcare professionals take more time off from work than the amount they are allotted with the majority of absences being for no official reason.&amp;lt;ref name=&amp;quot;understandinggovernmentfailureinpublichealthservices&amp;quot;/&amp;gt; India&amp;#039;s public healthcare system pays salaries during absences, leading to excessive personal days being paid for by the government. This phenomenon is especially heightened in Sub Centres and PHCs and results in expenditure that isn&amp;#039;t correlated to better work performance.&amp;lt;ref name=&amp;quot;understandinggovernmentfailureinpublichealthservices&amp;quot;/&amp;gt;&lt;br /&gt;
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===Overcrowding of clinics===&lt;br /&gt;
Clinics are overcrowded and understaffed without enough beds to support their patients. Statistics show that the number of health professionals in India is less than the average number for other developing nations.&amp;lt;ref name=&amp;quot;betterhealthsystemsforIndiaspoor&amp;quot;/&amp;gt; In rural [[Bihar]] the number of doctors is 0.3 for every 10,000 individuals. Urban hospitals have twice the number of beds than rural hospitals do but the number is still insufficient to provide for the large number of patients that visit.&amp;lt;ref name= &amp;quot;healthcareandequityinindia&amp;quot;/&amp;gt; Sometimes patients are referred from rural areas to larger hospitals, increasing the overcrowding in urban cities.&amp;lt;ref name=thechallengesconfrontingpublichospitalsinindia&amp;gt;{{cite journal|last1=Bajpai|first1=Vikas|title=The Challenges Confronting Public Hospitals in India, Their Origins, and Possible Solutions|journal=Advances in Public Health|date=13 July 2014|volume=2014|pages=27|doi=10.1155/2014/898502|doi-access=free}}&amp;lt;/ref&amp;gt;&lt;br /&gt;
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Overcrowding also increases the likelihood of diseases spreading, particularly in urban, crowded areas of cities. Improper sanitation and waste disposal, even within clinics, can lead to an increased incidence of infectious diseases.&amp;lt;ref&amp;gt;{{Cite journal|last=Ezeh|first=Alex|date=16 October 2016|title=Improving the health and welfare of people who live in slums|url=http://wrap.warwick.ac.uk/83214/1/WRAP_Slum%20Health%20Paper%202-%20RESUBMISSION_FINALCOPY_CLEAN.pdf|journal=The Lancet|volume=389|issue=10068|pages=559–570|doi=10.1016/S0140-6736(16)31848-7|pmid=27760702|s2cid=3511402}}&amp;lt;/ref&amp;gt;&lt;br /&gt;
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=== Poor cooperation between public and private spheres ===&lt;br /&gt;
5% of visits to health practitioners are in private clinics or hospitals, many of which are paid for out of pocket. Money is spent on improving private services instead of on funding the public sector.&amp;lt;ref name=&amp;quot;understandinggovernmentfailureinpublichealthservices&amp;quot;/&amp;gt; Governmental failure to initiate and foster effective partnerships between the public and private healthcare spheres results in financial contracts that aren&amp;#039;t negotiated to help the common man. These contracts would allow the private sector to finance projects to improve knowledge and facilities in the public sphere.&amp;lt;ref name=&amp;quot;twelfthfiveyearplan&amp;quot;/&amp;gt;&lt;br /&gt;
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===Barriers of access===&lt;br /&gt;
Both social and financial inequality results in barriers of access to healthcare services in India. Services aren&amp;#039;t accessible for the disabled, mentally challenged, and elderly populations.&amp;lt;ref name=&amp;quot;twelfthfiveyearplan&amp;quot;/&amp;gt; Mothers are disadvantaged and in many rural areas there is a lack of abortion services and contraception methods. Public clinics often have a shortage of the appropriate medicines or may supply them at excessively high prices, resulting in large out of pocket costs (even for those with insurance coverage).&amp;lt;ref name=&amp;quot;twelfthfiveyearplan&amp;quot;/&amp;gt; Large distances prevent Indians from getting care, and if families travel far distance there is low assurance that they will receive proper medical attention at that particular time.{{cn|date=May 2023}}&lt;br /&gt;
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=== Hospital fires ===&lt;br /&gt;
Many government hospitals do not follow the fire safety norms set in the National Building Code of India owing to cost saving measures and the preference for the lowest bidder in construction projects.&amp;lt;ref name=&amp;quot;:0&amp;quot;&amp;gt;{{Cite web |last=Barnagarwala |first=Tabassum |title=Why Indian hospitals turn into raging infernos |url=https://scroll.in/article/1021669/why-indian-hospitals-turn-into-raging-infernos |access-date=2022-08-02 |website=Scroll.in |date=13 April 2022 |language=en-US}}&amp;lt;/ref&amp;gt; Due to this there have been frequent news reports of major hospital fires across India.&amp;lt;ref&amp;gt;{{Cite web |title=14 Covid Patients In ICU Killed In Maharashtra Hospital Fire |url=https://www.ndtv.com/india-news/12-icu-patients-dead-in-fire-at-hospital-in-maharashtras-virar-2419980 |access-date=2022-08-02 |website=NDTV.com}}&amp;lt;/ref&amp;gt;&amp;lt;ref&amp;gt;{{Cite web |date=2022-08-01 |title=Madhya Pradesh: Eight dead, 5 injured in Jabalpur hospital fire |url=https://indianexpress.com/article/india/jabalpur-hospital-fire-madhya-pradesh-deaths-injured-8064038/ |access-date=2022-08-02 |website=The Indian Express |language=en}}&amp;lt;/ref&amp;gt;&amp;lt;ref&amp;gt;{{Cite news |title=Dozens die in India hospital fire |language=en-GB |work=BBC News |url=https://www.bbc.com/news/av/world-asia-india-16105161 |access-date=2022-08-02}}&amp;lt;/ref&amp;gt; According to a [[Scroll.in]] report, the main reason for this vulnerability to electrical short circuits is the lack of dedicated electrical engineers in most hospitals and shortage of government electrical engineers in the various state public works departments. The same report found that between August 2020 to March 2022 there were 122 deaths due to 29 incidents of hospital fires during that period.&amp;lt;ref name=&amp;quot;:0&amp;quot; /&amp;gt;&lt;br /&gt;
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== References ==&lt;br /&gt;
{{Reflist}}&lt;br /&gt;
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{{Health in India}}&lt;br /&gt;
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[[Category:Health programmes in India]]&lt;br /&gt;
[[Category:Publicly funded health care]]&lt;/div&gt;</summary>
		<author><name>Ajay Kumar</name></author>
	</entry>
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