India’s G20 presidency: An agenda for healthcare

Source– The post is based on the article “India’s G20 presidency: An agenda for healthcare” published in The Indian Express on 21st December 2022.

Syllabus: GS2- Issue related to development and management of health

Relevance– Global cooperation in field of new agenda for healthcare

News– The article explains the agenda of healthcare for the 21st century which should be adopted by G20 under the Indian presidency. It explains the concept Universal Healthcare and

PHC-with-UHC approach.

What are the initiatives by G20 for the healthcare system?

It has been one of the priority areas for G20 deliberations. The first meeting of health ministers of G20 countries was organised in 2017 by the German presidency.

The G20 now has health finance in its financial stream and health systems development in the Sherpa stream. An annual G20 meeting of health ministers and a joint health and finance task force reflects the seriousness the subject has gained.

The Berlin Declaration 2017 of the G20 health ministers provided a composite approach focusing on pandemic preparedness, health system strengthening and tackling antimicrobial resistance. The Indonesian presidency in 2022 made it the major focus.

What is the concept of Universal Healthcare?

The concept of UHC was born in the 2000s. It was meant to prevent catastrophic medical expenditures due to secondary and tertiary level hospital services by universalising health insurance coverage. It was also adopted in 2015 as the strategy for SDG-3 on ensuring healthcare for all at all ages.

However, the limited impact of this narrow strategy was soon evident. Expenditures on outdoor services became catastrophic for poor households. It prevented access to necessary healthcare and medicines. Many unnecessary medical interventions were being undertaken.

How has the PHC-with-UHC approach developed?

In 2018, the Astana Conference organised by WHO and UNICEF put out a declaration stating that primary healthcare is essential for fulfilling the UHC objectives. In 2019, the UN General Assembly adopted the combined UHC-PHC approach as a “political declaration”.

The World Bank published a report in 2021. The dominant hospital-centred medical system is becoming unaffordable even for the high-income countries. However, these global vision documents, while adding primary level care to UHC, are not addressing the nature of hospital systems themselves and their linkages.

What is the PHC-with-UHC approach?

It means strengthening primary level care linked to non-medical preventive action through whole-of-society and whole-of-government approaches. It extends the “PHC principles” to secondary and tertiary care services.

It must additionally include the more recent initiatives that can be clustered together under five themes–

First, making health central to development in all sectors. One health that links animal and human health should be adopted.

Second, is health systems strengthening. There is a need to design PHC-with-UHC for diverse contexts. It should be conceptualised as a continuum of care — from self-care in households to community services, to primary level services and to all hospital services.

Third, appropriate technologies should be adopted as a norm. It should be done by strengthening health technology assessment, ethics of healthcare, equitable access to pharmaceutical products and vaccines, integrative health systems using plural knowledge systems rationally.

Fourth, health and healthcare should be looked at from the perspective of the marginalised. Gendered health care needs, Health care of indigenous peoples globally, occupational health, mental health and wellbeing, healthy ageing should be promoted.

Fifth, decolonisation and democratisation of health knowledge is needed with interests and perspectives of low-middle-income countries.

What are pioneering initiatives by India that can contribute to the PHC-with-UHC discussion?

Lessons from the National Health Mission for strengthening public health delivery.

The HIV-control programme’s successful involvement of affected communities and a complex well-managed service structure.

Pluralism of health knowledge systems, each independently supported within the national health system.

Health personnel such as the ASHAs, mid-level health providers and wellness centres, Traditional community healthcare providers with voluntary quality certification;

Research designed for validation of traditional systems.

Pharmaceutical and vaccines production capacity.

Developments in digital health and social insurance schemes and people’s hospital models by civil society.

What is the way forward for strengthening the global healthcare system?

There is a requirement of the drafting of PHC-with-UHC with a broad global consensus and commitment to a more sustainable and people-empowering health system.

Pursuing such an agenda would involve much dialogue within countries, regions and globally. This process could be kick-started by working through the G20 Indian presidency. It should call for organising a global conference on rethinking healthcare systems that moves a Declaration on Sustainable and Empowering Health Care for the 21st Century.