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Achieving Universal Health Coverage (UHC) in India

Last updated on January 27th, 2025 Posted on January 27, 2025 by NEXT IAS Current Affairs Team  463

Syllabus: GS2/Health

In Context

  • The excerpt from “Mission Possible” by Swami Subramanian and Aparajithan Srivathsan presents a visionary roadmap for achieving UHC in India, emphasizing the importance of technology, team-based care, and a strong public health system.

About Universal Health Coverage (UHC)

  • It is a global health objective aimed at ensuring that everyone can access essential health services without facing financial hardship. It encompasses the full range of health services, from health promotion and prevention to treatment, rehabilitation, and palliative care, and is a critical component of Sustainable Development Goal 3 (SDG-3).

Key Components of UHC

  • Availability: Adequate health services in sufficient quantity.
  • Accessibility: Equal access regardless of location or socio-economic status.
  • Affordability: Health services without financial strain.
  • Quality: High-quality services meeting population needs.
Health and the Indian Constitution
– State List (List II, Schedule VII): Public health, sanitation, hospitals, and dispensaries.
– Concurrent List (List III, Schedule VII): Family welfare, population control, medical education, and prevention of food adulteration.
– Article 263: Establishes the Central Council of Health and Family Welfare for policymaking in health and family welfare matters.
– Right to Health: Interpreted by the judiciary as part of the Right to Life (Article 21).

Challenges in Achieving UHC in India

  • High Out-of-Pocket Expenditure (OOPE): Despite government health expenditure rising to 1.84% of GDP (2021-22), OOPE remains a significant burden for many households.
  • Limited Health Insurance Coverage: The ‘missing middle’—a segment of the population without insurance—remains financially vulnerable to medical expenses.
  • Resource Constraints: Shortages in financial, clinical, and infrastructural resources, especially in low-income regions, hinder healthcare delivery.
  • Rising Non-Communicable Diseases (NCDs): Growing prevalence of NCDs demands a shift toward preventive care and long-term management.
  • Public-Private Collaboration: Stronger partnerships are needed to expand healthcare access and improve service delivery.
  • Digital Transformation: While promising, implementing digital solutions in healthcare faces challenges like infrastructure gaps and digital literacy.

Key Recommendations

  • Leveraging Modern Technology: Technology acts as the “glue” binding a network of healthcare workers, from community health workers to specialists in tertiary hospitals.
    • Integrated health teams using tools like mobile phones and electronic medical records can enhance efficiency and accessibility.
  • Strengthening the Public Health System: The Bhore Committee report (1946) laid the foundation for India’s public health system with its three-tier model integrating preventive and curative care.
    • Improving public health as the primary provider of promotive, preventive, and curative services, reducing health expenditure while ensuring quality.
    • Integration of private healthcare with the national system can improve access and outcomes.
  • Creating an Integrated Health System:  The Public Health Foundation of India recommends:
    • Universal Health Insurance to protect against financial hardship.
    • Establishing autonomous organizations for evidence-based healthcare practices.
    • Training appropriately skilled healthcare workers.
    • Decentralizing and coordinating health governance.
    • Legislating health entitlement for all Indians.
  • Community Health Worker Teams: Community health workers can perform 75% of a doctor’s duties, enabling local access to healthcare.
    • Each worker would serve a population of 40,000, supported by a 75-bed district hospital for tertiary care.
    • Training MBBS and MSc biotech students in community medicine for three months would prepare them for grassroots healthcare.
  • Indian Medical Service (IMS): Proposal for creating an Indian Medical Service (IMS) similar to the IAS, with advanced certification (MD) holders managing state-level healthcare.
    • This would improve governance and ensure professional management of public health systems.
  • Role of Private and Specialty Care:
    • Private medical centers and foundations should coexist with public healthcare to expand quality care.
    • Examples from South India’s ophthalmology institutions demonstrate the success of a pyramidal four-tier model, where local eyecare workers connect with world-class research centers using advanced technologies for diagnosis and treatment.
  • Road to UHC: Aadhaar-like identification systems for healthcare delivery.
    • World-class medical facilities in each state (e.g., AIIMS, Delhi; NIMS, Hyderabad).

Source: TH

 
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