Suspicion of Shots: Examining the Relationship Between the State, Society, and Health in India

In India, the need to strengthen and integrate the overall healthcare system has been a a long acknowledged issue, but little has been done to address Indians deep-rooted sense of mistrust of the state which hinders cohesive health initiatives. India’s health system is characterized by an bureaucratic-heavy framework, which manifests in a multifaceted and complex government health system. I hope to account for how coercion, corruption, poor implementation, and unreliability built the sense of mistrust that exists between individuals and the state, tracing from the colonial efforts at smallpox vaccination to today. By unpacking the components of mistrust that exist, I hope to uncover reasons for the mix of healthcare successes and failures in India. How does this history of mistrust inform people’s interactions with the healthcare system? I will be focusing on two programs: the Integrated Child Development Service (ICDS) and the National Rural Health Mission (NRHM). The ICDS, created in 1975 to improve childhood development and women’s health via community-level mobilization, has been chronically underfunded and poorly managed, and now only functions properly with NGO supervision. The second, the National Rural Health Mission (NRHM), has been cited as the biggest (and most ambitious) attempt to improve access, equity, quality, accountability and effectiveness of public health services. The program is the model for the National Health Mission, which aims to extend services to all Indians in the next five years. What factors play into making a program accessible and palatable by the public? Why is the NRHM more successful and more widely supported than previous horizontal health programs in India? Is it a difference in ownership of implementation? Its structure? What makes one fuel a healthcare overhaul for the country while the other falls into disrepair? Global pressure? What makes certain programs susceptible to corruption and mismanagement? Underlying all of these questions about the contemporary health system in India will be: how has the past relationships between the state and the individual influenced the interactions in healthcare today?