Challenges of Universal Health Coverage (UHC)

General Studies Paper -2

Context: Universal Health Coverage (UHC) is a critical goal for India, however, achieving UHC presents a complex array of challenges due to the diverse and multifaceted nature of the country’s healthcare landscape.

About Universal health coverage (UHC)

• It is a global health objective that aims to ensure all people have access to the health services they need without suffering financial hardship.
• It includes a full range of essential health services, from health promotion and prevention to treatment, rehabilitation, and palliative care.
• Achieving UHC is a critical component of the Sustainable Development Goals (SDGs-3) which focuses on ensuring healthy lives and promoting well-being for all at all ages.

Key Components of UHC

• Availability: Ensuring that health services are available in sufficient quantity.
• Accessibility: Making sure that health services are accessible to everyone, regardless of their location or socio-economic status.
• Affordability: Providing health services without causing financial hardship.
• Quality: Ensuring that health services are of high quality and meet the needs of the population.

Current State of UHC in India

• The National Health Policy 2017 articulates the goal of achieving the highest possible level of health and well-being for all citizens.
  • Despite this, disparities in healthcare access and quality persist across different states and regions.
• For instance, Himachal Pradesh, Kerala, and Tamil Nadu spend ₹3,829, ₹2,590, and ₹2,039 per capita respectively, while Uttar Pradesh and Bihar spend only ₹951 and ₹
  • It highlights the need for tailored UHC plans that consider the unique realities of each state.

Key Challenges in Achieving UHC in India

• Diverse Health Systems: India’s health systems vary widely across states, reflecting different levels of development and healthcare infrastructure.
  • For instance, states like Kerala and Tamil Nadu have relatively advanced healthcare systems, while states like Bihar and Uttar Pradesh lag behind in terms of healthcare expenditure and outcomes.
• Inequities in Health Outcomes: States with similar population sizes and health indicators can have vastly different healthcare outcomes. For example, teenage pregnancy rates and fertility rates vary significantly, impacting the overall health indicators.
  • For instance, West Bengal, despite having a low fertility rate, has one of the highest teenage pregnancy rates in the country.
• High Out-of-Pocket Expenditure: In states like West Bengal (remains high at 67%) and Andhra Pradesh, out-of-pocket expenses account for a significant portion of total health expenditure, indicating that increased government spending alone is not sufficient.
• Systemic Challenges: The coexistence of multiple health system types within the same state can complicate the implementation of a unified UHC plan.
  • Additionally, the varying levels of healthcare infrastructure and workforce across states further complicate efforts to provide equitable healthcare access.
• Infrastructure Gaps: India faces significant healthcare infrastructure deficits, particularly in rural areas.
  • Many regions lack adequate healthcare facilities, medical equipment, and essential medicines.
  • It is more pronounced in states with lower healthcare spending.
• Workforce Shortages: There is a critical shortage of healthcare professionals, including doctors, nurses, and allied health workers.
  • It is exacerbated by uneven distribution, with rural and remote areas being the most affected.
• Policy and Governance Issues: Effective implementation of UHC requires robust policy frameworks and governance structures.
  • However, challenges such as bureaucratic inefficiencies, lack of coordination between different levels of government, and corruption can hinder progress.

Related Government Initiatives Achieving UHC in India

• Ayushman Bharat: It is aimed at providing health coverage to over 500 million people. It includes two major components:
• Health and Wellness Centres (HWCs): These centres aim to provide comprehensive primary healthcare services, including preventive, promotive, rehabilitative, and curative care.
• Pradhan Mantri Jan Arogya Yojana (PM-JAY): It provides health insurance coverage of up to ₹5 lakh per family per year for secondary and tertiary care hospitalization.
• Pradhan Mantri Ayushman Bharat Health Infrastructure Mission (PM-ABHIM): Launched to strengthen primary, secondary, and tertiary healthcare systems, this mission aims to develop capacities to detect and cure new and emerging diseases.
• National Health Mission (NHM): It includes the National Rural Health Mission (NRHM) and the National Urban Health Mission (NUHM), which aims to provide equitable, affordable, and quality healthcare services.
• These missions focus on reducing maternal and child mortality, controlling communicable and non-communicable diseases, and strengthening healthcare infrastructure.
• National Digital Health Mission (NDHM): It aims to create a digital health ecosystem by providing a unique health ID to every citizen, enabling seamless access to health records and services.
• Increased Public Health Expenditure: The government aims to increase public health expenditure to 2.5% of GDP, as outlined in the National Health Policy 2017.

Path Forward

• Strengthening Primary Healthcare: Investing in primary healthcare to ensure comprehensive and continuous care for all individuals.
• Reducing Out-of-Pocket Expenditure: Implementing policies to reduce the financial burden on individuals, such as expanding insurance coverage and subsidizing healthcare costs.
• Addressing Regional Disparities: Tailoring UHC plans to the specific needs of different states, considering their unique healthcare challenges and resource availability.

Conclusion

• Achieving universal health coverage in India requires a multifaceted approach that considers the diverse realities of each state.
• It involves not only increasing government health expenditure but also addressing systemic issues and health inequities.
• A tailored, region-specific strategy is essential to overcome the challenges and ensure that all Indians have access to quality healthcare without financial hardship.