ABOUT: A critical component of the United Nations' 2030 agenda for Sustainable Development Goals is health for all. However, despite a decade-long work under the National Rural Health Mission, a vast majority of Indians remains out of the heath care-for-all umbrella. The more recent National Urban Health Mission of 2013 and the Rashtriya Swasthya Bima Yojana have only just begun. The WHO representative to India, Dr. Henk Bekedam, suggests ways to marry national and state priorities to bring quality health care to every Indian citizen.
In the words of Dr. Margaret Chan, Director General of the World Health Organization, "Universal Health Coverage (UHC) is the single most powerful concept that public health has to offer."
Moving towards UHC in India
India has made rapid strides towards increasing access to health services in the past few years through a number of initiatives, including the flagship National Rural Health Mission (NRHM), launched in 2005. This was expanded to the urban population through the National Urban Health Mission (NUHM) in 2013.
To provide financial protection to targeted populations, including those below the poverty line, the government has implemented the Rashtriya Swasthya Bima Yojana (RSBY). It covers the cost of secondary-level hospitalisation.In addition, there are a number of state-specific schemes. Some involve running free diagnostics facilities and offering free medicines; others are government-funded health insurance schemes in several states. Evidence suggests that these can reduce the financial burden on patients and increase attendance at public health facilities.
The need to accelerate UHC in India
While these initiatives provide some financial protection to those seeking health care, tens of millions still fall into poverty after an illness or abstain from accessing the health services they need.
At 60 per cent, India's out-of-pocket expenditure (OOP) for health is one of the highest in the world. This exacerbates health inequities. To sustain its economic growth, India will need to have a healthy population and address health inequities. In this context, UHC can be the driver and benefit the entire population.
Accelerating UHC is the key to successfully addressing the new public health challenges and inequities in health outcomes.
Despite remarkable achievements such as polio eradication and maternal and neonatal tetanus elimination, to name a few, there are several health challenges. The country is facing a double burden resulting from significant increase in non-communicable diseases (NCDs) associated with lifestyle and the pre-existing burden of communicable diseases.
Environmental issues such as air pollution have also become a major concern. The high pollution levels in Delhi is a case in point.
Another challenge is inequities in health outcomes and access to health services. The Maternal Mortality Ratio (MMR) varies from 61 per 100,000 live births in Kerala to 300 in Assam. Differences also exist in health indicators between urban and rural/remote areas - infant mortality rate, or IMR, estimated at 27 per 1,000 live births in urban areas, is 44 per 1,000 live births in rural areas. In addition, disparities in coverage of essential intervention exist even within the well-performing states. For example, immunisation coverage in Tamil Nadu varies from about 34 per cent in Kanyakumari district to 75 per cent in Vellore district.
Here are the eight recommendations for accelerating the progress towards UHC.