Universal Health Coverage

The actionable strategies for bringing Universal Health Coverage (UHC) to the doorstep of people in India are encapsulated in Mission Possible. This country houses 143 crores of populations of which 38 are children and 11 are geriatric populations-it needs solutions that are not only innovative and governed in synergy but also center around quality delivery for healthcare.

Universal Health Coverage Challenges in India

• Public Health Expenditure and Primary Healthcare System
  • India spends only 1.9% of its GDP on healthcare, which results in over-reliance on tertiary care and neglect of primary health systems. Many diseases, such as diabetes and hypertension, remain undiagnosed until complications set in, which sends patients to tertiary care.
• Regional Disparities in Healthcare Access
  • Healthcare infrastructure is not well distributed. Urban areas have better facilities than rural areas.
  • There is an availability of gaps more than 80% of rural CHCs in surgeons, physicians, pediatricians, and nearly 75% in obstetricians and gynecologists.
• High Burden of Non-Communicable Diseases
  • The country of India has shifted rapidly towards NCDs that cause deaths with a rate of 65-66%.
  • Health inequity has been amplified through pollution, poor sanitation, and malnutrition.
• Inefficient Government Programs Implementation
  • Flagship schemes like Ayushman Bharat aim to cover health coverage for 50 crore citizens, but poor awareness and uneven implementation hinder their reach.
• Poor Health Insurance Penetration
  • 95% of India’s population remains uninsured, 73% lack health coverage.
  • High Out-of-Pocket Expenditure on health is impoverishing some 55 million Indians annually.
• Fragmentation in Healthcare Governance
  • Indian federalism creates siloed and often non-aligned health policies that hardly interlink between the center and states.
• Low Preventive Healthcare
  • Although preventive care, such as immunization, screening, and lifestyle changes, are cost-effective, there is low usage of preventive care.
• Low Technology and Digital Health Adoption
  • Digital health plans through ABDM seek to digitize health records, yet penetration is low in rural regions.
• Excessive Private Sector Dependence
  • Overcrowding in public hospitals and poor quality of treatments, pushes patients into the expensive private sector for care.

Key Recommendation for Strengthening Universal Health Coverage

• Enhancing Public Health Expenditure and Health Insurance
  • India should increase public health spending to 2.5% of GDP by 2025.
  • Expanding programs like PM Ayushman Bharat, Health Infrastructure Mission can bridge infrastructure gaps.
  • Insurance through targeted schemes can reduce financial burden on vulnerable populations.
  • India can learn from the Beveridge Model and Bismarck Model for universal healthcare funded through taxation.
• Strengthening Primary Health Care
  • Primary health centers need to be renovated, with proper staffing, equipment, and medicines.
  • Preventive health screening for all NCDs and other diseases should be made compulsorily available at PHC level. It will decrease the long-term disease burden.
  • Health camps on a large scale will help in the early identification of problems, especially in rural and tribal areas.
• Workforce strengthening
  • Scaling up medical and paramedical education with proper working conditions.
  • Health-related training for nurses, midwives, and community health workers under the Skill India scheme may also help bridge the shortage.
• Advancement in Digital Health Technology
  • Accelerating ABDM shall involve providing a seamless experience to patients for registration, receiving treatment, and overall healthcare delivery.
  • Internet facilities through BharatNet and digital training for health workers will be available to every corner of the country without any denial.
• Focus on Preventive Healthcare
  • Preventive measures like vaccination, health education, and lifestyle modification can reduce disease burden and costs.
  • Strengthening of urban sanitation under Swachh Bharat Mission 2.0 and increased funding for National Programmes like the NPCDCS will have far-reaching impacts.
• Public-Private Partnerships
  • PPPs can be used for infrastructure development, diagnostics, and tertiary care.
  • Schemes such as the Viability Gap Funding for private hospitals in underserved areas improve access but do not involve increasing costs unbearably.
• Reducing Regional Disparities
  • Incentives under the central schemes may encourage states with lower health indices to improve healthcare infrastructure and workforce efficiency.
• Strengthening Regulatory Mechanisms
  • The primary thrust should be toward effective price control of essential medicines and unification of treatment charges in all private hospitals.
• Investment in Research and Indigenous Innovations
  • Fund institutes like ICMR to develop affordable, indigenous healthcare solutions.
• Integrating Traditional Medicine with Modern Healthcare
  • Scaling up the National Mental Health Programme (NMHP) and integrating it with primary healthcare through telemedicine platforms can make services accessible.
• Integrating One Health Approach
  • Establish integrated monitoring systems for zoonotic diseases and expand the scope of the National Centre for Disease Control (NCDC) to collaborate with veterinary and wildlife departments.

Way Forward

• Strengthening the Public Health System
  • Strengthen the public health system that provides promotive preventive and curative health services.
  • Integration of the private sector to decrease healthcare costs and improve quality.
• Leveraging Technology
  • Modern information technology that includes electronic medical records and mobile tools is a must for the delivery of health care. Technology facilitates more effective coordination among health care teams ranging from community health workers to specialists.
• Health Care Teams and Infrastructure
  • Local physicians lead healthcare teams that have support from community health workers who take on up to 75% of all routine medical tasks.
  • State level has to provide top class infrastructural facilities including AIIMS like in Delhi and NIMS like in Hyderabad.
• Training and Capacity Building
  • MBBS and MSc biotechnology students need training for three months in community medicine.
  • Establish an Indian Medical Service (IMS) to supervise and administer statelevel health services like IAS at the district level.