National healthcare programs and policies in India:an ontological analysis

Abstract

Background: The healthcare system in India is facing multitude of challenges owing to the changing epidemiology of health as well as diseases. Despite having the distinction of being one of the largest public healthcare delivery systems in the world, our health indicators reflect a grim picture in comparison to global targets. India has large number of national healthcare programs and sub-programs, policies, and legislations. Though they are meant to be inclusive and comprehensive the results are far from the desired vision.

Methods: Using a logically constructed ontology based on the common body of knowledge as a lens, we map all the programs and policies to reveal the ‘bright’, ‘light’, and ‘blind/blank’ spots in them. The ontological maps are constructed at different levels of granularity–monads and dyads. They provide a synoptic, systematic, and systemic assessment of the policies while highlighting their emphases and biases.

Results: In terms of the Focus, the dominant focus of the programs and policies is on information (30) and education (39), drugs (26), administration (31), finance (24), and treatment (28). These are the ‘bright’ spots. Their secondary focus is on technology (18), personnel-staff (12), personnel-physician-specialist (7), and personnel-nurses (8). These are the ‘light’ spots. The tertiary focus is on insurance (4). These are the ‘blind/blank’ spots.

Conclusions: The coverage of the National Programs/Policies on healthcare, viewed through the lens of the ontology is patchy. Yet, overall, almost all elements in the ontology find expression in at least one program/policy – an indicator of their extensive coverage. There is absence of frequent co-occurrence of the outcomes, except quality and accessibility. This paper presents the first step in a program of research which can be used to analyse and direct healthcare policy globally, nationally, and locally.