IMPLEMENTING UNIVERSAL HEALTH COVERAGE

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THE CONTEXT: Universal Health Coverage (UHC) is a global initiative to ensure access to quality health services for all citizens without financial hardship. India, with its diverse demographic and health challenges, faces various barriers to achieving UHC. These include inadequate public financing, fragmented health services, lack of political demand, and a healthcare workforce shortage.

ISSUES:

• Constitutional Mandate for Health: There is a vacuum of constitutional mandate for the fundamental right to essential health in India. While the Directive Principles of State Policy in the Constitution provide a basis for the right to health, there is no explicit provision guaranteeing this right. The constitutional amendment may be necessary to elevate health to a fundamental right, ensuring better health outcomes and fulfilling the UHC objectives.
• Public Financing for Health: The high-level expert group report submitted to the Planning Commission in 2011 recommended increasing public financing for health to 2.5% of India’s GDP during the 12th Plan (2012-17). The National Health Policy 2017 also aligns with this goal, aiming for universal access to good-quality healthcare services without financial hardship.
• Primary Healthcare and Migrant Population: There is a need to focus on primary healthcare, especially for the large migrant population in India. With a significant number of inter-state migrant workers and a high urban slum population, the availability and accessibility of primary health services for these groups is quintessential. Healthcare services should be portable to accommodate the mobility of the migrant population.
• Out-of-Pocket Expenditure: Reducing out-of-pocket expenditures is a critical component of UHC policy. Simplifying reimbursement processes and adapting cash transfers in the public healthcare system to better serve migrant and marginalized communities should be realized. This would help alleviate the financial burden on individuals seeking healthcare.
• Inclusive Health Systems: Create an inclusive health system by integrating health management information system dashboards with public and private systems. This emphasizes the need for better information systems considering language barriers and diversity, particularly in urban areas.
• Community-Based Primary Healthcare: Implementing community-based primary healthcare in urban and peri-urban areas with seamless referral systems. Integrating services at the primary healthcare level to ensure follow-up and adherence to healthcare is essential for reducing the disease burden and improving the country’s financial health.

THE WAY FORWARD:

• Increase Public Financing for Health: A significant increase in public health financing is essential. As envisaged in the United Nations Sustainable Development Goals, at least 5% of the Gross Domestic Product (GDP) should be earmarked for public health to achieve UHC by 2030. This aligns with the World Health Organization’s advocacy for an increase in Primary Health Care (PHC) spending by at least 1% of the GDP.
• Establishment of a Public Health Commission: To operationalize multisectoral public health action in a decentralized manner, a Public Health Commission is recommended. This commission would coordinate various initiatives across sectors, ensuring a unified approach to public health.
• Decentralization and Community Engagement: Decentralization of planning, implementation, and monitoring of health services to build a sustainable system rooted in local sociocultural contexts. Every village or urban ward should have an Arogya Kendra (health center) financed by the state but managed by local volunteers under community guidance.
• Inter-sectoral Coordination with a “Health in All” Approach: Adopting an inter-sectoral coordination approach ensures that health considerations are integrated into all public policies. This approach can address social determinants of health and promote a healthier population.
• Regulatory Reforms and Engagement with the Private Sector: Implement regulatory reforms to improve the quality of care and effectively engage the private sector in UHC goals. This includes strategic purchasing and provider payment reforms to ensure efficient resource use.
• Global Best Practices: Learning from global best practices such as England’s Health and Social Care Act 2012, which reorganized health services to create a more efficient system, and Thailand’s National Health Security Act 2002, which established the right to standard and efficient health service for all citizens.

THE CONCLUSION:

To achieve Universal Health Coverage (UHC) in India, we need constitutional amendments, increased public funding, decentralization of health services, incentivizing medical personnel to work in rural areas, technology, public-private partnerships, inter-sectoral coordination, strategic purchasing, payment reforms, and healthcare industry regulation.

UPSC PAST YEAR QUESTIONS:

Q.1 Appropriate local community-level healthcare intervention is a prerequisite to achieving ‘Health for All ‘in India. Explain. 2018

Q.2 Professor Amartya Sen has advocated necessary reforms in primary education and primary health care. What are your suggestions for improving their status and performance? 2016

Q.3 The public health system has limitations in providing universal health coverage. Do you think that the private sector could help in bridging the gap? What other viable alternatives would you suggest? 2015

MAINS PRACTICE QUESTION:

Q.1 Discuss the challenges and potential solutions to achieve Universal Health Coverage (UHC) in India, focusing on strengthening primary healthcare, reducing out-of-pocket expenditure, and ensuring equitable access to health services for all citizens, including the migrant population.

SOURCE:

https://www.thehindu.com/opinion/op-ed/implementing-universal-health-coverage/article68039225.ece