UPSC DAW Mains Answer Writing 2025 12th August

UPSC DAW Mains Answer Writing 2025 12th August

Question

Despite institutional mechanisms for public participation, citizen engagement in health governance in India remains limited and often tokenistic. Examine the challenges in ensuring inclusive community participation and suggest measures to strengthen it. (10 marks, 150 words) 

Model Answer

Introduction:  

  • Health governance refers to the processes, structures, and norms through which decisions about health policy, planning, and implementation are made, involving both state and non-state actors. NITI Aayog’s ‘Healthy States, Progressive India’ report (2021), states with higher community participation in health planning show better primary health outcomes. 

 Challenges in Ensuring Inclusive Participation: 

  • Structural and Institutional Barriers 

  • Inactive or Non-functional Committees: In several states, Village Health Sanitation & Nutrition Committee(VHSNC) either don’t exist or meet infrequently; utilisation of untied funds remains low (MoHFW, NRHM Evaluation 2018). 

  • Ambiguous Roles & Overlapping Mandates: Poor clarity on powers of local health bodies reduces their influence in decision-making. 

  • Attitudinal Barriers 

  • Provider-Centric Approach: Policymakers often treat citizens as beneficiaries, not rights-holders. 

  • Resistance to Shared Power: Fear of increased accountability or interference deters genuine participation (BMJ Global Health, 2019). 

  • Socio-cultural and Power Asymmetries 

  • Social Hierarchies: Marginalised groups, women, Dalits, Adivasis, are often excluded or silenced in public forums. 

  • Language & Literacy Barriers: Health information remains inaccessible to many. 

  • Capacity & Awareness Deficits 

  • Lack of Civic Awareness: NFHS-5 data shows poor awareness of entitlements like free essential drugs or patient rights in rural areas. 

  • Low Technical Understanding: Citizens often lack tools to critically evaluate service quality. 

  • Weak Integration Across Sectors 

  • Poor coordination between health, sanitation, nutrition, and social welfare departments undermines holistic engagement. 

Measures to Strengthen Inclusive Participation: 

  • Empowering Communities 

  • Legal Backing: Recognise health as a justiciable right (as in Paschim Banga Khet Mazdoor Samity vs State of West Bengal, 1996). 

  • Rights Education: Disseminate information on Patient Rights Charter and governance platforms through ASHAs, Panchayats, and local media. 

  • Reserved Representation: Mandate representation of marginalised groups and women in health committees. 

  • Capacity Building & Tools 

  • Social Accountability Mechanisms: Scale up Community-Based Monitoring and Planning (CBMP) under NHM, shown in Maharashtra to improve immunisation coverage and reduce absenteeism. 

  • Participatory Audits: Use Jan Sunwai (public hearings) and Citizen Report Cards for health facilities. 

  • Sensitising Health System Actors 

  • Integrate public health and community engagement modules into medical and administrative training (as recommended by NITI Aayog Health Systems Strengthening Report, 2021). 

  • Incentivise collaborative problem-solving rather than target-only performance evaluation. 

  • Digital and Hybrid Platforms 

  • Create district-level digital dashboards for public feedback on services (similar to Mera Aspataal app). 

  • Use IVR and WhatsApp-based surveys for remote areas. 

  • Intersectoral Convergence 

  • Integrate VHSNC work with Swachh Bharat Mission, Poshan Abhiyaan, and Jal Jeevan Mission for holistic outcomes. 

 Conclusion:  

  • Citizen participation is not an add-on but a core democratic imperative for equitable health governance. Moving from tokenism to genuine co-creation requires legal empowerment, institutional strengthening, social accountability mechanisms, and attitudinal change within the health system. As the WHO Commission on Social Determinants of Health (2008) affirmed – ‘Closing the health gap requires closing the power gap.’