Universal Health Coverage-Indias path to inclusive health care

Source-This post on Universal Health Coverage -Indias path to inclusive health care has been created based on the articles “Implementing universal health coverage” and “Shaping India’s path to inclusive health care” published in “The Hindu” respectively on 7 April 2024.

UPSC Syllabus-GS Paper-2– Issues Relating to Development and Management of Social Sector/Services relating to Health, Education, Human Resources.

Context– The World Health Day is observed every year on April 7 by The World Health Organization (WHO). The theme this year is “My Health, My Right”. It highlights the significance of health equity. Health equity ensures that every person has an equal opportunity to achieve their highest health potential irrespective of their circumstances. It is determined by social norms, political, legal and other structural determinants.

Further, the National Health Policy also talks about Universal Health Coverage as one of its goals. Universal health coverage (UHC) signifies universal accessibility to comprehensive, high-quality health services, without financial hardship.

What are the challenges before India to attain health equity?

1) Health Disparities- As per 2011 census, more than 17% of Indias metropolitan area are slums, which face significant health disparities.  According to the Indian Council of Medical Research, infectious diseases like tuberculosis are 1.5 times more prevalent in slums compared to non-slum areas.

2) Social discrimination- As per the National Family Health Survey (NFHS)-5 (2019-21) data, Scheduled Castes and Scheduled Tribes experience higher child mortality and lower immunization rates.
Further, 59% of poor women suffer from anemia which is almost double the rate in the higher income groups.

3) Rise of non-communicable diseases (NCDs)-It account for more than 60% of all fatalities in India. As per The Public Health Foundation of India, economic effect of NCDs could cross $6 trillion by 2030.

4) Paucity of doctors– WHO data indicates that India has only 0.8 doctors per 1,000 people, which is below the advised ratio. Rural areas have an acute shortage of doctors.

5) Right to health– India does not have a constitutional provision for the fundamental right to basic health. The constitutional right to health is critical to break the vicious cycle of poverty and poor health.

6) Issues faced by migrant workers– India has a large migrant population. According to UN-Habitat/World Bank, 49% of the urban population lives in urban slums. Urban slums do not have access to clean drinking water and sanitation.

What should be the way forward?

1) Ensure portability of health care services– Access to health care should be made more mobile and portable for migrant workers.

2) Minimize out-of-pocket expenditure-There is a need to simplify reimbursement processes for reducing out-of-pocket expenditure. The design of cash transfers and reimbursement in India’s public healthcare system should be adapted as per the needs of migrant and marginal communities.

3) Inclusive health systems-In order to overcome language barriers and diversity in the urban context, there is a need to integrate health management information system dashboards with both public and private systems. This will make the health system more inclusive to all sections of society.

4) Strengthening primary health care-There is a need to strengthen and implement community-based primary healthcare in urban and peri-urban areas with seamless referral systems.

5) Health Literacy-In order to achieve the target of Universal Health coverage and health equity, there should be more focus on health literacy. India should include health education in National Health Mission. This would empower the people to make educated health decisions.

6) Leveraging the role of NGOs– Organizations with a strong local presence are essential for ensuring health equity. In this context, it is important to leverage the role played by the non-governmental organizations and civic societies because they engage directly with grass roots community. They can help in tailoring health initiatives that are culturally sensitive to the community’s unique needs.

7) Evidence-based practices-Research institutes and academic institutions can offer insights into health inequalities and the efficacy of health interventions. This will assist in creating evidence-based practices.

Read more- Healthcare Initiatives in The Budget

Question for practice

What are the impediments to achieve health equity in India. What steps can be taken to ensure universal health coverage and health equity in India?