In trying to achieve “health for all” universally, the World Health Organisation (WHO) on the World Health Day this year provides impetus to countries to move towards universal health coverage (UHC). It is noteworthy that the Indian government in its latest Budget provides a framework for universal health coverage through its ambitious National Health Protection Scheme (NHPS), which prioritises healthcare delivery and its access. Clearly this time there is a political will towards taking concrete steps to advance the health of all people, an aim of Sustainable Development Goals 2015 to which India like other UN member countries is committed in fulfilling the agenda by 2030. It principally ensures that everyone, everywhere can access essential quality health services without facing financial hardship. Investing in UHC is important as it is the pathway towards enhancing people’s health and life expectancy, and India needs to soundly invest in this since it still has much to do in healthcare provisions with life expectancy lower than many Asian countries and, of course, the developed world both at birth and at the age of 60, even though India has improved its statistics in the last two decades.
With structured policy dialogue on how to advance UHC for instance by expanding service coverage, improving quality of services, reducing out-of-pocket payments, countries and in particular India from 2018 onwards with NHPS in place has the power of transforming health of its people. With the right kind of implementation measures India can ensure all people get quality health services, where and when they need them, without suffering financial hardship. With the nation’s flagship Ayushman Bharat programme in which 1.5 lakh health and wellness centres will provide free essential drugs and services and upgrade district medical colleges to 24 new government medical colleges and hospitals, complex healthcare access challenges to a large extent and can be addressed. The need is to meet the expectations of the people with a shift from designing health systems around diseases and institutions towards health services designed around and for people. The choice for policy and programme is only the people’s health and well-being, and that makes UHC feasible.
The challenge in implementing UHC is in utilising funds allocated for healthcare for all without discrimination, leaving no one behind. Everyone everywhere has a right to benefit from health services. UHC enables everyone to access services that address the most important cause of disease and death and ensures that the quality of those services is good enough to improve the health of the people who receive them. The past experiences of the country indicate under utilisation of healthcare funds, particularly, in certain states among certain segments of the population, and the issues connected with this remain unaddressed. In addition, there is minimal emphasis on incentivising research and development which should be an important component for strengthening the pharmaceutical sector, streamlining drugs, patents, clinical trials, etc, essential for delivering appropriate services and care. The healthcare expenditure in totality and through a holistic approach has to be seen as an investment that yields high returns for all ages of the population. A critical evaluation of our healthcare system can open our minds to understand the lack of emphasis in the past on infrastructure, public health and human resource development in the health field for providing healthcare for all with no gender and age bias. After all UHC requires progressive expansion of coverage of health services and financial protection as more resources become available, including public health services and safety and security campaigns for all, health facilities and communications networks, health technologies, information systems, quality assurance mechanisms and above all governance and legislation to put in place all systems which affect health of the people.
It is now recognised world over that UHC is a key strategy to make progress towards health-related and broader development goals. It not only improves access to quality care and financial protection, but also protects countries from epidemics, reduces poverty and the risk of hunger, creates jobs, drives economic growth and enhances gender equality. The present government at the Centre with an eye on the upcoming 2019 general election has announced through UHC a massive expansion of healthcare facilities, including provisions for secondary and tertiary care. It marks a significant expansion from past programmes and provides a mandatory amount of free healthcare cover to as many as 500 million people, making it the world’s largest funded government healthcare programme. As countries in their respective ways observe the World Health Day on April 7, governments through UHC make a sound investment in their human capital and will bring over one billion more people to benefit from UHC by 2023. WHO director-general rightly says: “No one should have to choose between death and financial hardship. No one should have to choose between buying medicine and buying food.” UHC indeed is a way to go ahead.
The writer is associate professor, department of sociology, Maitreyi College, University of Delhi, with specialisation in health, gerontology and development studies. Email LittleThingsMatter@gmail.com
