Home  /  Editorial Analysis  /  Challenges of Universal Health Coverage (UHC)

Challenges of Universal Health Coverage (UHC)

Last updated on December 19th, 2024 Posted on December 19, 2024 by NEXT IAS Current Affairs Team  29

Syllabus: GS2/Issues Related To Health

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.
Health and Constitution of India
– Public Health and Sanitation, Hospitals, and Dispensaries fall under the State List (List II, Schedule VII).
– Family Welfare and Population Control, Medical Education, Prevention of Food Adulteration, and Quality Control in the Manufacture of Drugs are included in the Concurrent List (List III, Schedule VII).
– The Central Council of Health and Family Welfare (set up under Article 263 of the Constitution) enables consideration and recommendation of broad lines of policy in regard to matters concerning health and family welfare.
Right to Health
– While the Constitution of India does not explicitly mention the right to health, it has been interpreted by the judiciary to be an integral part of the right to life under Article 21.

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 ₹701.
    • 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.
Daily Mains Practice Question
[Q] Discuss the major hurdles and potential solutions to achieving Universal Health Coverage (UHC) in India. Analyze the role of public-private partnerships and technological advancements in addressing these challenges.

Source: TH

 
Previous article Green Hydrogen and the Financing Challenge
Next article Challenges of Universal Health Coverage (UHC)