Citizen Engagement in Health Governance: A Critical Analysis for UPSC Aspirants

 Citizen Engagement in Health Governance: A Critical Analysis for UPSC Aspirants

By Suryavanshi IAS

Introduction

The recent state initiatives like Tamil Nadu’s Makkalai Thedi Maruthuvam (2021) and Karnataka’s Gruha Arogya (2024, expanded in 2025) highlight India’s shift towards doorstep healthcare delivery for non-communicable diseases (NCDs). While these schemes improve accessibility, they also raise an important governance question: How effectively can citizens participate in health policy-making?

This blog explores citizen engagement in health governance, linking it to UPSC’s General Studies (GS) Paper 2 (Governance) and GS Paper 3 (Health). We will also analyze previous UPSC questions (last 10 years) related to this topic.

---

Why Citizen Engagement in Health Governance Matters?

1. Democratic Accountability & Inclusivity

• Ensures policies reflect people’s needs, not just bureaucratic or medical elite decisions.
• Example: Village Health Sanitation and Nutrition Committees (VHSNCs) under NRHM (2005) aimed at decentralised health planning but faced challenges like infrequent meetings and underutilised funds.

2. Combats Epistemic Injustice

• Marginalised communities (Dalits, tribals, women) often lack representation in health policy.
• Example: Mahila Arogya Samitis in urban areas remain ineffective due to social hierarchies.

3. Improves Health Outcomes

• Engaged communities collaborate better with frontline workers (ASHA, ANMs).
• Example: Kerala’s People’s Planning Campaign (1996) improved local health governance.

---

Challenges in India’s Health Governance

Issue	Impact
Medical Dominance	Doctors (with biomedical training) lead health administration, ignoring social determinants of health.
Tokenistic Participation	Committees like VHSNCs exist on paper but lack real power.
Beneficiary Mindset	Citizens are seen as passive recipients, not rights-holders.
Lack of Structural Reforms	No incentives for administrators to involve communities.

---

UPSC Previous Year Questions (PYQs) – Prelims & Mains

Prelims Questions (Last 10 Years)

1. Which of the following is/are the key components of the National Health Mission (NHM)? (2018)

1.    ASHA workers

2.    Rogi Kalyan Samitis

3.    Janani Shishu Suraksha Karyakram (JSSK)

4.    Pradhan Mantri Swasthya Suraksha Yojana (PMSSY)

Answer: 1, 2, 3

• Explanation: PMSSY is a separate scheme for tertiary care, while NHM focuses on primary and secondary healthcare through ASHAs, VHSNCs, and Rogi Kalyan Samitis.

2. Consider the following statements about VHSNCs: (2016)

1.    They are mandated under the National Health Mission.

2.    They include PRI representatives.

3.    They monitor ICDS and sanitation.

Answer: 1, 2, 3

• Explanation: VHSNCs are part of NHM, involve Panchayati Raj members, and oversee health, nutrition, and sanitation.

---

Mains Questions (GS-2 & GS-3)

1. "Public participation in health governance remains weak in India." Discuss the reasons and suggest reforms. (GS-2, 2020)

• Key Points:
• Reasons: Medical dominance, bureaucratic resistance, lack of awareness.
• Reforms: Strengthening VHSNCs, training health administrators in participatory governance, social audits.

2. Critically examine the role of ASHA workers in India’s health system. (GS-2, 2019)

• Key Points:
• Successes: Bridge between communities and health systems.
• Challenges: Overburdened, low wages, lack of formal recognition.

3. How can India improve its healthcare delivery system for non-communicable diseases (NCDs)? (GS-3, 2021)

• Key Points:
• Doorstep schemes like Tamil Nadu’s Makkalai Thedi Maruthuvam.
• Preventive care through community engagement.

---

Way Forward: Reforming Health Governance

1.    Shift from ‘Beneficiary’ to ‘Rights-Holder’ Approach – Use terms like "health rights-holders" instead of "beneficiaries."

2.    Strengthen Local Committees – Regular meetings, social audits, and untied funds for VHSNCs.

3.    Training for Administrators – Public health leadership courses for IAS/health officers.

4.    Inclusive Participation – Reserved seats for marginalised groups in health committees.

---

Conclusion

India’s health governance needs structural reforms to move beyond tokenistic participation. Schemes like Makkalai Thedi Maruthuvam are commendable, but without empowered citizen engagement, they risk becoming top-down interventions.

For UPSC aspirants, this topic is crucial for GS-2 (Governance) and GS-3 (Health). Previous questions show UPSC’s focus on decentralisation, ASHA workers, and NCD management—making this a high-yield area for 2025-26.

---

For more UPSC insights, follow Suryavanshi IAS!