Introduction
Public health in India has seen significant development since independence. The primary goal has been to improve the overall health status of the population, especially in rural areas, by focusing on preventive and promotive health care. Over time, India’s public health system has evolved through several phases, shaped by national policies, global health movements, and local needs.
Early Years (Post-Independence)
After 1947, India faced serious health challenges including high mortality rates, communicable diseases, and inadequate healthcare infrastructure. The Bhore Committee (1946) laid the foundation for public health by recommending:
- A three-tier system of health care – Primary, Secondary, and Tertiary levels
- Universal access to health services
- Focus on preventive and curative health
This led to the establishment of Primary Health Centres (PHCs), Sub-Centres, and District Hospitals.
Health Programmes and Policies
- National Health Policy (1983, 2002, 2017): Laid the strategic framework for improving access, quality, and affordability of healthcare.
- Expanded Programme on Immunization (EPI) (1978): Later became Universal Immunization Programme (UIP), a major success in controlling vaccine-preventable diseases.
- Integrated Child Development Services (ICDS) (1975): Focused on nutrition and health of mothers and children.
- National Rural Health Mission (NRHM) (2005): Strengthened rural health infrastructure and services through ASHAs and increased funding.
Role of Major Health Missions
1. National Health Mission (NHM)
Launched in 2013 by combining NRHM and National Urban Health Mission. It strengthened public health delivery in both rural and urban areas, especially in maternal and child health, disease control, and health system strengthening.
2. Ayushman Bharat (2018)
Focused on providing universal health coverage through two components:
- Health and Wellness Centres (HWCs) – to deliver comprehensive primary health care
- Pradhan Mantri Jan Arogya Yojana (PM-JAY) – health insurance for secondary and tertiary care
Improvements in Public Health Indicators
- Increase in life expectancy from 32 years (1947) to over 70 years
- Significant decline in infant and maternal mortality rates
- High immunization coverage
- Reduction in communicable diseases like polio, smallpox, and leprosy
Challenges in Rural Public Health
- Shortage of trained medical professionals
- Limited infrastructure in remote villages
- Lack of awareness about health and hygiene
- Prevalence of non-communicable diseases and mental health issues
Conclusion
Public health development in India has made significant strides in the last seven decades. From tackling epidemics to ensuring vaccination and health insurance, the focus has broadened to include preventive, promotive, and curative care. However, continued investment in rural health infrastructure, digital health, and human resources is crucial for sustainable and inclusive health outcomes across the country.