Reviving Civic Engagement in Health Governance
Why in News?
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State-level schemes such as Tamil Nadu’s Makkalai Thedi Maruthuvam (Aug 2021) and Karnataka’s Gruha Arogya (Oct 2024, expanded June 2025) aim to deliver doorstep health care for non-communicable diseases.
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Raises a key question: Are citizens equally empowered to engage in and influence health governance formally?
Background
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Shift in health governance: From purely government-led to multi-actor spaces — includes civil society, professional bodies, hospital associations, trade unions.
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Engagement happens through formal (committees, public platforms) and informal (community mobilisation, protests) channels.
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Significance: Upholds democratic values, self-respect, reduces corruption, challenges elite dominance, builds trust between communities and providers.
Institutional Mechanisms for Engagement
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Rural: Village Health Sanitation & Nutrition Committees (VHSNCs), Rogi Kalyan Samitis under NRHM (2005).
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Urban: Mahila Arogya Samitis, Ward Committees, NGO-led groups.
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Design intent: Inclusive of women, marginalised groups; supported by untied funds.
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Challenges:
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Committees absent in some areas; in others, inactive.
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Ambiguous roles, infrequent meetings.
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Underutilisation of funds.
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Poor intersectoral coordination.
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Social hierarchies restricting participation.
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Key Issues
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Mindset Problem
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Communities seen as passive beneficiaries, not rights-holders or co-creators.
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Performance measured via targets (no. of beneficiaries), not quality or experience.
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Medicalised governance: Leadership dominated by doctors trained in biomedical models, often without public health admin training.
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Promotions by seniority, not expertise → detachment from community realities.
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Resistance Factors
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Fear of increased workload & accountability.
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Regulatory capture by dominant medical/capitalist interests.
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Lack of level playing field in governance processes.
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Alternative Channels
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Protests, media campaigns, litigation — showing unmet need for participation.
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Way Forward
1. Mindset Shift
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Community engagement as a democratic right, not just a means to meet programme targets.
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Respecting agency and dignity of citizens.
2. Empower Communities
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Disseminate health rights & governance platform info.
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Foster civic awareness early.
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Intentional outreach to marginalised groups.
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Provide knowledge, tools, and resources for effective participation.
3. Sensitise Health System Actors
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Move beyond blaming “poor awareness” for low utilisation.
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Recognise structural determinants of health inequities.
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Treat communities as partners.
4. Strengthen Platforms
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Activate existing engagement committees.
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Ensure inclusivity, regular functioning, and follow-up on community inputs.
