Health systems have been evolving in response to the changing healthcare needs of people. People want to be healthy. They want to live longer. They do not want to fall ill. They want a prompt response if they fall sick. They want to be cured of their illness. If they can’t be cured, they want relief from pain and suffering. They want it at home or near it. They want to receive care in dignity, with compassion and empathy. They would not like to be denied care because they cannot afford it or because they belong to a particular race, religion, caste, gender, etc.

Can health systems alone meet the above needs? People need safe drinking water, clean air, hygienic surroundings, a place to live, a healthy diet, playgrounds, education, employment, etc., to remain healthy. These are not in the purview of health systems. They encompass entire social systems. The Ministry or departments of health alone cannot meet the above. There is a need for the ‘whole of government’ and ‘whole of society’ approach to people’s health. It is not enough to target people’s health. It is equally important to target the health of all living beings, as pathogens can jump from one living being to the other. It is not enough to target only living beings. Keeping our environment healthy is equally important for the health of all living beings.

Longevity is not decided by how robust is the health system. Social determinants enumerated above account for two-thirds of longevity and functioning health systems account for the balance. Intersectoral coordination is vital to make people live longer. People do not want to live longer with disability and suffering. Hence, preventing disease, deaths, and disability becomes a primary function of health systems. Inculcating healthy lifestyles in school goes a long way in preventing many diseases. Educating a girl child and preventing malnutrition in an adolescent girl is as important as good maternity care in eliminating maternal deaths.

A well-designed comprehensive primary health care (PHC) system, embedded in the social milieu, responsive through community engagement, and linked with community health workers drawn from the communities they serve – be urban or rural, shall address all the issues mentioned above to be called a people-centered health system. It should undertake health status (longevity, disability-adjusted life years, disease burden, etc.,) and needs (acute vs chronic, promotive vs preventive vs curative vs palliative, etc.,) assessment from time to time to be responsive. It should engage in imparting population-relevant health education and providing correct medical information. It should ensure that everyone is looked after equally without any discrimination. It should strive to build people’s trust in the system. 

While public health needs outlined above are under the purview of governments, the medical needs of people are met by a variety of providers in a variety of ways. Not all providers are driven by the ethic of patient-centered care. Not all are driven by safe, timely, and effective care. Governments may not be in a position to provide needed medical care to all. However, governments can purchase care from non-governmental providers. As purchasers, they should ensure that the beneficiaries get the right medical care in a timely fashion. Governments can also enact laws to enforce quality assurance from health goods (drugs, devices, disposables, diagnostic reagents, etc.) and all healthcare service providers.

Many people may not know how to remain healthy and when and where to seek healthcare. Many diseases remain silent until they are far advanced. Many acute conditions like heart and brain strokes are left with irreversibly damaged tissues if the time from the onset is delayed leading to long-term disabilities. People may not know as to which provider has the needed infrastructure and competencies to attend to their medical emergency. They may not know where their financial cover (public, social or private health insurance) is eligible. It is the responsibility of the public health system and health insurers to inform, educate, and communicate (IEC) people to make them more aware and guide them to navigate complex healthcare systems.

It is also important to understand health seeking behavior of people. Multiple factors underlie health seeking behavior of people – age, gender, proximity, prior experience, health awareness, affordability, health financial cover, cultural and religious beliefs, trust, education, digital literacy, media, marketing promotions, etc. Governments can orchestrate people-centered healthcare through conducive policies, enforceable regulations, financing through priority setting, and nudging market forces. Non-governmental systems should be engaged to bring them on board for people-centered healthcare.

How people finance their health needs has become as important as how they meet their health needs. Governments are mandated to provide free healthcare to people. However, the public healthcare provided is either not adequate, not accessible or not of reasonable quality. The net result is that people end up paying out of their pockets or they forego needed healthcare or they forego other basic needs like food, education, housing, etc. People-centered health systems should strive to ensure that no one is denied care because they can’t afford it. All healthcare providers should strive to make their operations more efficient to optimize the cost of provision. Constrained governments should prioritize their investments in promotive and preventive healthcare thereby reducing the demand for curative and palliative care. People should put their own efforts into adopting healthy lifestyles to prevent falling ill. Pooling of finances and health risks is a well-established strategy to provide coverage to all. There are attempts to pool philanthropic and corporate social responsibility funds to bridge gaps. Social responsibility is being promoted as a standard corporate culture for sustainable development. Fintech is transforming consumer financing. It can ease the pain of borrowing very high-interest unsecured loans to fund health emergencies that are not covered.

People’s needs during public health emergencies are compounded by the need to quarantine, isolate, stock essential medicines and groceries, have access to procedures like dialysis, look after the children, have access to broadband connectivity for studying and working from home, to face loss of jobs and wages, etc. In addition, people need finances to fund their emergency needs if one of their family members gets affected. Local governments and self-help groups should prepare, keeping in view the unique needs of a health emergency.

While global, national, and subnational level health systems are essential in medium to long-term plans, families, communities, local health systems, local social systems, and local governments are best positioned to understand people’s health and social needs and be responsive. Strengthening local governments through the devolution of powers is essential to build resilient health and social systems.

Krishna Reddy Nallamalla,
President, InOrder, the Health Systems Institute
South Asia Regional Director, ACCESS Health International       

Photo Credits: Global Giving

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