Community Engagement in Health Governance in India

The article discusses the shift in health governance in India, emphasizing the importance of public engagement in shaping health policies and systems. It critiques the traditional view of communities as passive recipients of care and highlights initiatives aimed at health governance improvement.

Key Initiatives

• Makkalai Thedi Maruthuvam: Launched in Tamil Nadu in 2021, this scheme aims to deliver healthcare directly to people’s homes.
• Gruha Arogya Scheme: Initiated in Karnataka in October 2024 and expanded by June 2025 to all districts, focusing on doorstep healthcare for non-communicable diseases.

Challenges in Health Governance

• Health governance, traditionally led by the government, now involves diverse actors, including civil society and professional bodies.
• Public health spending in India has not significantly benefited poorer sections.
• Scattered public health services and fragmented governance highlight the need for systemic improvements.

Importance of Public Engagement

• Public engagement is crucial for affirming self-respect and upholding democratic values.
• Inclusive participation promotes accountability, challenges elite dominance, and reduces corruption.
• Engagement fosters collaboration with frontline workers and supports better health outcomes.

Platforms for Engagement

• National Rural Health Mission (NRHM): Launched in 2005, it institutionalized public engagement through Village Health Sanitation and Nutrition Committees (VHSNCs) and Rogi Kalyan Samitis.
• Urban participation platforms include Mahila Arogya Samitis, Ward Committees, and NGO-led committees.

Challenges in Implementation

• Committees face challenges like ambiguous roles, infrequent meetings, and underutilization of funds.
• Policymakers often view communities as passive, focusing on target-based metrics rather than participatory processes.

Need for a Mindset Shift

• Resistance to public engagement arises from concerns over workload, accountability, and regulatory capture.
• Citizens often resort to protests and media campaigns to voice their needs.

Recommendations for Improvement

• Empower Communities: Disseminate information about health rights and foster civic awareness.
• Sensitize Health System Actors: Move beyond blaming poor awareness and focus on structural determinants of health inequities.
• Establish and strengthen platforms for public engagement.

The article emphasizes that participatory processes are as vital as the outcomes they aim to achieve, advocating for health professionals to view communities as partners rather than passive recipients.