As we observe World Health Day, the emphasis on achieving universal health coverage (UHC) in countries in all regions of the world and particularly in the Southeast Asian and African regions becomes stronger and stronger. It is not only the World Health Organisation’s (WHO) number one goal this year but also a focus of many governments to ensure that everyone can obtain the healthcare they need, have access to it closest to their home, community and whenever they need it. Many nations including India realise that often their citizens have to choose between spending on healthcare and meeting their daily living expenses. People in general and especially those residing in rural and remote areas do not have access to quality and affordable healthcare. Primary healthcare centres lack the basic health facilities for newborn and child health, for maternal health, for non-communicable diseases for adult as well as geriatric populations, for mental health diseases and other ailments arising out of environmental issues. The gap between regions across countries and within a country reinforces the importance for equity in health care services after all health is a human right which must be realized by all leaving no one behind.
While many governments, be they in China, India, Malaysia, Thailand, to name a few countries, are currently strengthening the package of services and appropriate quality of care at the primary healthcare level along with augmenting provisions for healthcare at the secondary and tertiary segments, sound and scientific data to analyse who is being missed out is not being taken into account for policy, programme and delivery matters, which then limits the scope of providing effective access to health services for all, given the age, gender, education, income and other differentials. For instance, as populations are ageing across nations, older people are being left behind in accessing affordable comprehensive health care. Not only are geriatric services underdeveloped in many emerging economies, older people are also most vulnerable in not being able to use the limited health care facilities available because of distance, unfriendly and non enabling environmental factors, poor transport facilities, illiteracy, disability, lack of family support, financial constraints, and so on.
It has been observed that most healthcare systems emphasise on treatment, disease control, on medical conditions rather than on prevention, rehabilitation and promotion of health and well-being which should be the goal of primary healthcare as part of universal healthcare coverage. While efficient screening of health problems is still an unaccomplished goal, immunization and vaccine program for young and adults alike is also not yet universal. The primary health care system has much to be desired in terms of cost-effective, equitable short- and long-term care as well as emergency care. Scarcity of allocation of funds, shortage of medical, nursing and paramedical personnel, clinics and hospitals, medical education facilities, all contribute towards challenges for achieving universal health care coverage. As it is recognised worldwide, UHC can only be achieved if there is sufficient health work force and medicines. A disturbing fact of India’s health status is that every year as per certain estimates 55 million people are propelled into poverty because of spending on medicines. Out-of-pocket expenditures on healthcare are high In India as surveys and research indicates.
In India the new and recent policy directive to upgrade existent medical centres into 1.5 lakh health and wellness centres and convert 1,50,000 sub-centres into active delivery points for comprehensive primary health services is a promising initiative of the central government for improving antenatal care, immunisation, family planning, disease prevention, diagnostic and treatment services, community-based health promotion in dealing with communicable and non-communicable diseases. Further the provision of insurance payments, which would ease use of network of secondary and tertiary level of private hospitals and facilities for care, is an encouraging sign of making the UHC robust. However, a pertinent question arises as to whether the private sector, which caters to 80 percent outpatient health care and 60 per cent inpatient healthcare, will engage with the public sector that for many is a chronically ill system in India. The implementation of the UHC in this private public partnership is not going to be an easy task as observed by many critics of the government policies. Private healthcare system with its emphasis on profits may not function in rural and remote areas and in addition may not welcome regulations and monitoring of its functioning, without which we cannot have a desirable accountable and transparent healthcare system.
Through the “Modicare” mechanism India has no doubt fast-tracked many initiatives aimed at achieving UHC, what needs to be considered is how the healthcare system will be strengthened to provide diagnostic services at reduced and affordable costs as well as improve access to free medicines. A worthwhile step taken by the central government is the initiative called Amrit, an acronym for Affordable Medicines; Reliable Implants for Treatment. The government has planned centres that provide medicines for cancer; cardiovascular diseases and cardiac implants at significantly reduced prices, thus making affordable the much-needed facility. It has also opened Jan Aushadhi (people’s medicine) stores to make available quality essential medicines to people in need.
We have progressed over a year since Ayushman Bharat, the thrust for India’s journey towards UHC, was announced in the Union Budget 2018. Budget allocations for the success of the programme have taken place but much still needs to be done in order to make available trained health personnel at all levels to provide treatment and care for prevention, promotion and diagnostic facilities for all age groups, including for the emerging non-communicable medical needs such as end-of-life care. In India, the achievement of the UHC goal will depend on ramping up and revitalising the health system with services available at the community level for all sections of the population. The nexus between public and private healthcare provisions to ensure quality of care is a big challenge towards achieving the goal of UHC with all its core tenets intact, but it must be met so as to reach sustainable development goals by 2030.
The writer is a sociologist, gerontologist and health and development social scientist, and an associate professor at Delhi University’s Maitreyi College.
