Universal Health Coverage (UHC)- Explained Pointwise

December 12 is recognized as International Universal Health Coverage (UHC) Day. UHC is firmly grounded in the 1948 WHO Constitution, which declares health a fundamental human right and commits to achieving the highest attainable standard of health for all.

In India, achieving UHC is both a challenge and an opportunity, given its population size, economic diversity, and healthcare disparities. This article explores the concept of UHC, its evolution, India’s progress, and the challenges and solutions in achieving this goal. Universal Health Coverage Explaination

What is Universal Health Coverage (UHC) and how has it evolved?

Universal Health Coverage (UHC)– According to the World Health Organization (WHO), UHC means that “all people have access to the full range of quality health services they need, when and where they need them, without financial hardship.” It is embedded in the Sustainable Development Goals (SDG target 3.8).

UHC has three key dimensions:

UHC covers the full continuum of essential health services, from health promotion to prevention, treatment, rehabilitation, and palliative care across the life course.

Key guiding principles of UHC– It is guided by the principles of equity, non-discrimination, and the right to health, focusing on reaching marginalized populations to ensure no one is left behind.

Evolution of the Idea of UHC

The concept of UHC has evolved over decades:

What measures has India taken to achieve UHC?

India’s commitment to UHC is reflected in its policies, programs, and constitutional provisions. Articles 39(e), 42, and 47 of the Indian Constitution mandate the State to improve public health and ensure access to quality healthcare. Some significant initiatives include:

1. National Health Mission (NHM)- It aims to achieve universal access to equitable, affordable, and quality healthcare services that are accountable and responsive to people’s needs. Under this mission, technical and financial support is provided to States and Union Territories to strengthen the public healthcare system. The mission comprises two sub-missions:
a. National Rural Health Mission (NRHM)
b. National Urban Health Mission (NUHM)

2. National Health Policy (NHP) 2017- It focuses on achieving UHC to all at affordable cost  by strengthening primary care, integrating AYUSH, leveraging digital tools, and collaborating with the private sector.

3. Ayushman Bharat Program- This flagship program aims to achieve universal health coverage and consists of two main components:
a. Health and Wellness Centres (HWCs): It delivers comprehensive primary care.
b. Pradhan Mantri Jan Arogya Yojana (PM-JAY): It provides health insurance coverage of ₹5 lakhs per family annually for secondary and tertiary care.

4. Ayushman Bharat Digital Mission (ABDM)- It will enhance equitable access to quality healthcare. This is by promoting technologies like telemedicine and ensuring national portability of health services through the creation of ABHA (Ayushman Bharat Health Account) numbers for citizens.

5. Other important schemes and programmes- Include the National Mental Health Programme (NMHP), National Programme for Health Care of the Elderly, POSHAN 2.0 for nutrition, and Fit India Campaign for promoting healthy lifestyles.

What is the current status of India’s healthcare Sector?

What are the challenges in implementing UHC in India?

1. Inadequate Public Health Expenditure– Despite being the world’s most populous country, India spends only 1.9% of its GDP on healthcare (Economic Survey 2023-24), while the WHO recommends 3%. This results in substandard quality of public healthcare.

2. Regional Disparities- Healthcare infrastructure is unevenly distributed, with urban areas having access to superior facilities compared to rural areas. For example, while 70% of India’s healthcare professionals are located in urban regions, 65% of the population resides in rural areas.

3. Struggling Primary Health Centres (PHCs)- Primary healthcare is vital for universal health coverage, but PHCs face key challenges that hinder their performance. It includes limited access, lack of trust between patients and providers, insufficient funding, poor infrastructure, and weak governance.

4. Unregulated Private Sector: In urban India, private hospitals provide approximately 74% of outpatient care and 65% of hospitalization services. However, these hospitals are mostly unregulated, resulting in high treatment costs and the prevalence of unethical practices.

5. Low Focus on Preventive Healthcare: Preventive measures like immunization, screening, and lifestyle changes are underused despite being cost-effective. According to NFHS-5, in 2021, India’s full immunization coverage was just 76.4%, leaving many children at risk.

6. Low Health Awareness– Factors like low educational levels, poor functional literacy, and limited focus on health contribute to low awareness about personal well-being. For example, many Indian women are unaware of the benefits of exclusive breastfeeding for children, resulting in issues like stunting and malnutrition.

What are the recommendations for achieving UHC in India?

1. Increase Healthcare Spending: India must significantly boost healthcare funding, aiming to allocate 3%-5% of GDP to healthcare. This can be achieved by enhancing public-private-philanthropic partnerships and adopting blended finance models to mobilize additional resources.

2. Shift from Sick Care to Preventive Healthcare: Strengthening Primary Health Centers (PHCs) with adequate staff, equipment, and focus on preventive care is essential. Initiatives like the Fit India Movement and increased emphasis on yoga, along with mandatory preventive screenings, can reduce long-term disease burden and healthcare costs.

3. Improve Access in Rural Areas: The government should incentivize private players to build healthcare infrastructure in rural areas. Tax incentives and financial rewards for doctors practicing in underserved regions, along with establishing medical colleges in rural areas, can help address workforce shortages.

4. Strengthen Health Insurance Systems: Expanding the scope of insurance policies, including outpatient packages, will improve financial protection. The inclusion of diagnostic services for non-communicable diseases (NCDs) can reduce healthcare costs through early identification.

5. Embrace Digital Health and Innovation: Expanding the Ayushman Bharat Digital Mission and integrating telemedicine platforms will ensure access to healthcare, especially in remote areas. Supporting research and indigenous innovations in health technologies will further strengthen India’s healthcare system.

6. Blending Traditional Medicine with Modern Healthcare- Integrating AYUSH (Ayurveda, Yoga, Unani, Siddha, Homeopathy) with modern healthcare can enhance India’s health system. Including AYUSH practitioners in Health and Wellness Centres under Ayushman Bharat can ease the load on allopathic doctors and offer culturally accepted alternatives.

7. Regulating the private sector: A standardized system for healthcare quality reporting should be established, requiring hospitals, physicians, and insurance companies to mandatorily report basic input indicators.

Conclusion

Achieving Universal Health Coverage in India is a daunting yet achievable goal. It requires a concerted effort to address systemic challenges, reduce inequalities, and prioritize preventive and primary healthcare. With a strategic focus on equity, quality, and financial protection, India can fulfill its constitutional mandate of ensuring health as a fundamental right. A robust healthcare system is not only essential for societal well-being but also critical for India’s aspiration to become a global economic powerhouse.