ABSTRACT
Universal Health Coverage (UHC) has become the global goal for health systems development, adopted also as a strategy for achieving the sustainable development goal (SDG) 3. While initially focussed on hospital services, it has increasingly been realised that UHC cannot happen without the primary healthcare approach (PHCA) and a connect with communities. However, this remains the weakest link, a reason being the limited consideration of community perspectives in health system design and practice. This chapter will focus on community perceptions and communisation, for their significance in health system design and implementation in contemporary times.
Planned development of any sector requires a deep understanding of user behaviour and perceptions. Patient-centred healthcare and people-centred health systems are widely accepted attributes in contemporary discourse. The widely acknowledged strategy of UHC for achieving SDG 3 also needs a contextual understanding. People’s health-related perceptions and behaviour remain marginal to health systems development and health policy in India. This chapter will illustrate the nature of research findings available to fill the gap and draw out their implications.
As a narrative review and policy analysis study, it will draw from the author’s interdisciplinary research over the past four decades, combining epidemiology, health systems research, and health culture studies for health policy and planning. It will begin with an analysis of the contemporary healthcare crisis globally and thereby argue the need for rethinking health system design. Bringing together findings from existing studies on people’s perceptions, especially of Dalit manual worker communities, and from traditional health knowledge systems, it will illustrate the complex nature of people’s understandings of health and healthcare as well as epistemological diversity. Finally, policy initiatives for communitisation under the National Rural Health Mission (NRHM) framework will be examined to analyse how attention to people’s perceptions can make their implementation more effective. Steps to institutionalise the shift to people-centred rather than merely institution-centred policy and planning, with consideration of community perceptions for bridging the top-down and bottom-up perspectives, can lead to more effective, sustainable, and democratic health systems.
