Universal Health Coverage (UHC)

General Studies Paper-2

Context: The Union Health Minister said that “India’s health system embraces a “whole of government” and “whole of society” approach to achieve Universal Health Coverage (UHC).

What is Universal Health Coverage?

• It means that all people have access to the full range of quality health services without financial hardship.
• Key components of UHC include:
• Access to Care: Everyone should be able to obtain necessary health services when they need them.
• Quality Services: The care provided should be effective, safe, and of good quality.
• Financial Protection: Individuals should not face financial difficulties due to medical expenses.
• Achieving UHC is one of the targets the nations of the world set when they adopted the 2030 Sustainable Development Goals (SDGs) in 2015.

UHC in India

• Constitutional Provisions: The Directive Principles of State Policy in Part IV of the Constitution provides a basis for the right to health.
• Article 39 (e) directs the state to secure the health of workers; Article 42 emphasises just and humane conditions of work and maternity relief; and Article 47 casts a duty on the state to raise the nutrition levels and standard of living, and to improve public health.
• The Constitution also endows the panchayats and municipalities to strengthen public health under Article 243G.
• India’s National Health Policy of 1983 recognized the goal of “Health for All” and emphasized the importance of primary healthcare and equitable distribution of healthcare resources.
• Currently, India aims to attain UHC through the expansion of the Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (AB-PMJAY), the flagship publicly financed health insurance (PFHI) scheme of the Union government.

Need of UHC in India

• Out of Pocket Expense: Over 40 percent of healthcare expenses in India are paid out-of-pocket, one of the highest rates worldwide.
• Consequently, these costs push more than 60 million Indians into poverty every year.
• The COVID-19 pandemic has underscored the critical need for robust and universal healthcare systems.
• Lack of Coordination: Although several social health insurance schemes exist nationally and within states, their coordination remains insufficient, leading to partial overlap and underutilisation of their full potential.
• Preventive Health Services: UHC emphasizes preventive health services, which can lead to early detection and management of diseases, ultimately reducing the burden of chronic conditions and improving population health.

Government Initiatives

• National Rural Health Mission (NRHM) Launched in 2005, was a flagship program of the Indian government aimed at strengthening healthcare in rural areas.
• The program focused on maternal and child health, immunization, nutrition, and communicable diseases.
• National Health Policy (2017): This policy aims to achieve UHC by providing quality healthcare services to all, with an emphasis on primary healthcare, preventive measures, and strengthening the healthcare infrastructure.
• Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (PM-JAY): In 2018, India launched the Ayushman Bharat program, which comprises two components – the Health and Wellness Centers (HWCs) and PM-JAY.
• PM-JAY is the world’s largest government-funded health insurance scheme, providing health coverage to over 500 million vulnerable individuals.

Challenges in Adopting UHC in India

• Resource Constraints: India faces significant funding limitations in healthcare, with a low public health expenditure compared to many other countries. This affects the ability to provide comprehensive services.
• Infrastructure Gaps: Many areas, especially rural regions, lack adequate healthcare infrastructure, including hospitals, clinics, and trained personnel, making access to care difficult.
• Healthcare Workforce Shortages: There is a shortage of healthcare professionals, particularly in rural areas, leading to disparities in access and quality of care.
• Fragmented Health Systems: India’s healthcare system is a mix of public and private providers, leading to inconsistencies in quality and accessibility.

Conclusion

• India has adopted several policies toward improving access to healthcare and has been an enthusiastic signatory to several global health policies to achieve UHC.
• However, despite these policy commitments, there has been limited success in realizing these goals.
• A healthy population is an empowered population. The lighter the disease burden, the better the country’s financial health.
• Committing to investing in health systems and effectively implementing UHC necessitates political will, substantial investment, and a clear, long-term vision.
• Establishing a coherent policy pathway to execute the national UHC policy consistently across States is imperative for its success.