Debates have risen in the context of Universal Health coverage and how it can be made feasible to implement ‘Health for All’ in a developing country like India.
What is Universal Health Coverage?
As per WHO, Universal health coverage (UHC) is the goal of ensuring that everyone has access to quality health services without financial hardship. UHC is based on the principles of equity, non-discrimination, and the right to health.
UHC includes
- Access: Everyone has access to the full range of health services, including health promotion, prevention, treatment, rehabilitation, and palliative care.
- Equity: UHC ensures that the most marginalized populations are reached and covered.
- Financial protection: UHC ensures that health services do not lead to financial hardship.
Constitutional Provisions
- Right to Health an integral part of right to life which is fundamental for all human beings under Article 21 of the Constitution.
- Article 47 of the Directive Principles of the Constitution states that the state is responsible for improving public health, raising nutrition levels, and improving the standard of living.
Current Status
- India has a mixed health system with both public and private sectors. The public sector provides healthcare services, but the private sector dominates in terms of service delivery and expenditure.
- Spending: India spends around 2.1% of GDP on healthcare (2023), below the WHO-recommended 5%. A significant portion of this is out-of-pocket (OOP) expenses.
Health Sector Overview in India
- Health Infrastructure: 1 government doctor per 1,511 people (WHO recommendation: 1:1,000).
- Public vs. Private: Private sector dominates healthcare, catering to nearly 70% of patients.
- Insurance Penetration: Pradhan Mantri Jan Arogya Yojana (PM-JAY) covers over 500 million people but leaves gaps for informal workers and urban poor.
Healthcare Statistics in India
- Out-of-Pocket Expenditure (OOPE): Accounts for 55-60% of total health spending, pushing ~55 million people into poverty annually.
- Life Expectancy: 69.6 years (Global average: 73 years).
- Infant Mortality Rate: 27 per 1,000 live births (2022), better than many developing nations but lags behind global benchmarks.
Troubles faced in Healthcare Sector
- Access to Healthcare:
- Approximately 70% of healthcare is financed through OOP expenditures, leading to financial hardship for many families.
- Insurance Coverage:
- Only about 25% of the population is covered by health insurance, with significant disparities between urban and rural areas.
- Healthcare Workforce:
- Shortage of healthcare professionals, with a doctor-to-population ratio of about 1:1,500, compared to the WHO recommendation of 1:1,000.
Challenges in Achieving UHC
- Access and Equity: Urban-rural divide and regional disparities.
- 70% of healthcare infrastructure is concentrated in urban areas, whereas 65% of India’s population resides in rural areas.
- Skewed Workforce: Shortages of doctors, nurses, and paramedics in underserved areas.
- 2.06 nurses per 1,000 population, short of the WHO recommendation of 3 per 1,000.
- Financial Protection: High OOPE due to low penetration of health insurance.
- Only 41% of the population is covered under any form of health insurance (NFHS-5).
- Quality of Care: Gaps in clinical care quality in public and private sectors.
- Less than 10% of private hospitals in India are accredited by NABH, indicating quality inconsistency.
- Governance Issues: Inefficient use of funds, corruption, and lack of accountability.
| Stakeholders | Pros of UHC | Cons of UHC |
| Patients | Reduced OOPE, improved access to care, healthier populations | Risk of exclusion errors in schemes like PM-JAY. |
| Government | Economic benefits via healthier workforce, social stability. | High fiscal burden, implementation challenges. |
| Private Sector | Increased insurance uptake, innovation opportunities. | Potential profit loss under capped pricing schemes. |
| Best PracticesIndiaTamil Nadu: Robust public healthcare system with free medicines and diagnostics.Kerala: Achieved near-universal immunization and lowest IMR in India.Haryana: Mukhyamantri Mufti Ilaj Yojana ensures free treatment for the poor.GlobalThailand: UHC achieved via progressive taxation, high citizen satisfaction.Cuba: Universal primary care through community-centric models.Rwanda: Community-based insurance, achieving >90% health coverage. |
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Interlinkage between Poverty and Health in Society
- Health and Poverty: Poor health traps families in cycles of poverty due to high OOPE.
- Health and Society: Poor healthcare access increases inequality and social unrest.
- Health and OOPE: Financial hardships due to OOPE reduce spending on education, food, and housing, perpetuating poverty.
Government Initiatives for supporting UHC
- National Health Policy 2017
- National Rural Health Mission (NRHM)
- National Urban Health Mission (NUHM)
- Launched four mission mode projects
- PM-Ayushman Bharat Health Infrastructure Mission (PM-ABHIM)
- Ayushman Bharat Health & Wellness Centres (ABHWCs)
- Pradhan Mantri Jan Arogya Yojana (PMJAY)
- National Digital Health Mission (NDHM)
Way Forward for Healthy India
- Integrated Approach: Combine public health campaigns with education and nutrition initiatives like PM POSHAN.
- Increase in the government’s health expenditure: To make universal healthcare accessible and affordable, the public health expenditure of the Centre and states together should be increased in a progressive manner to reach 2.5% of GDP by 2025, as per Economic Survey 2022-23.
- WHO-recommended 5% of GDP.
- Focus on Preventive Care: Reduce disease burden through immunization, clean water, and sanitation.
- Global Cooperation: Share best practices, and collaborate on pandemic preparedness.
- Accountability Mechanisms: Use technology for fund tracking and public grievance redressal.
- Strengthen Public Systems: Build rural health infrastructure, hire more workforce.
- Promote Insurance: Expand PM-JAY coverage, including informal workers.
- Regulate Private Sector: Cap treatment costs and ensure quality standards.
- Digital Health: Leverage telemedicine and health tech for remote areas.
- Rejuvenate UHC as part of India’s commitment towards achieving SDGs by 2030.
- UHC is included in Sustainable Development Goals (SDGs) target 3.8.
- Participate in WHO Collaborations like the UHC 2030 Partnership.
Conclusion
- By addressing systemic gaps and drawing from successful models, UHC can transform India’s health landscape while contributing to social equity and economic growth.
- Strengthening institutional capacity of the Indian Health system and fiscal devolution to the health sector will make UHC a reality in India. This will help us reap the demographic dividend of the Indian populace.
