Universal Health Coverage

Syllabus: GS2/ Health, Management of Social Sector, Issues Relating to Poverty & Hunger

In Context

• The expansion of Universal health coverage will be complex, but data and digital technology can smoothen the way. 

Universal Health Coverage

• Meaning:
  • Universal health coverage (UHC) means that all people have access to the full range of quality health services they need, when and where they need them, without financial hardship. 
  • It covers the full continuum of essential health services, from health promotion to prevention, treatment, rehabilitation, and palliative care across the life course.
• SDG target:
  • Achieving UHC is one of the targets the nations of the world set when they adopted the 2030 Sustainable Development Goals (SDGs) in 2015.
• UHC in India:
  • Currently, India aims to attain UHC through the expansion of the Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (AB-PMJAY), the flagship publicly financed health insurance (PFHI) scheme of the Union government. 

Challenges

• Off-track progress:
  • The world is off track to make significant progress towards universal health coverage (Sustainable Development Goals (SDGs) target 3.8) by 2030. 
• Stagnation:
  • Improvements to health services coverage have stagnated since 2015, and the proportion of the population that faced catastrophic levels of out-of-pocket health spending increased continuously since 2000. 
  • This global pattern is consistent across all regions and the majority of countries.
• Shortage of manpower:
  • Many Western and Central Asian nations today are staring at acute shortages of manpower in healthcare. 
• Disruption due to pandemic:
  • The COVID-19 pandemic further disrupted essential services in 92% of countries at the height of the pandemic in 2021. In 2022, 84% of countries still reported disruptions.
• Increasing poor and non-poor gap:
  • A greater proportion of disposable incomes is taken away from a poor household as compared to a non-poor one, further broadening the gap between the two.
    • If sickness hits a working member of the household, she/he must often withdraw from active employment and their main source of income dries up at the time when they urgently need more money for treatment.
    • Households have to often sell or mortgage their productive assets, such as land and cattle, to cover the treatment costs.
    • This further reduces their capacity to bounce back. 
  • According to the WHO, 55 million people fall into poverty or deeper poverty every year due to catastrophic expenditures on health.
• Lesser spending than the Lower and Middle-Income Countries:
  • India currently spends about Rs 8 lakh crore or about 3.2 percent of its GDP on health. 
  • This is much lower than the average health spending share of the GDP — at around 5.2 percent of the Lower and Middle Income Countries (LMIC).
  • Comparing the data:
    • Of this, the government (Centre and states put together) spends about roughly 1.1 percent of the GDP. 
    • Contrast this with the government health expenditure in countries like China (3 percent), Thailand (2.7 percent), Vietnam (2.7 percent) and Sri Lanka (1.4 percent).

Suggestions

• Global Initiative on Digital Health:
  • It is here that India’s leadership in digital health becomes significant. Under India’s G20 presidency, the WHO has launched a Global Initiative on Digital Health aiming to marshal investments into digital health and facilitate regional and international exchange and reporting on health. 
• Role of India’s Digital Health journey:
  • India’s own indigenous digital health movement, the Ayushman Bharat Digital Mission, preceded this initiative and is steadily gathering steam. 
  • Digital health must be seen as a tool for effectively managing the inevitably complex nature of UHC expansion.
    • Here, it will have a wide-ranging role to play, right from helping administer diverse contracts to implementing terms for value-based provider reimbursement and incentives. 
    • A robust digital and data infrastructure can address most of the challenges. 
• Role of AI:
  • Artificial Intelligence (AI) is rapidly transforming health care worldwide, and India has the potential to be at the forefront of this revolution. 
  • Diagnostics: One of the key areas where AI can make a significant impact is in diagnostics.
    • AI-powered tools can enhance the accuracy and efficiency of medical diagnoses, leading to faster treatment decisions and better patient outcomes. 
  • Predictions & preventions: Additionally, AI can help predict disease outbreaks, analyse health-care data, and optimise treatment plans, expediting health-care procedures, and revolutionising drug discovery ultimately making health care more personalised and effective.
• Need of Spreading the digital and data infrastructure:
  • India is not alone in this journey. Many low- and middle-income countries are also looking to build on their existing systems to expand UHC for their citizens. 
  • The Indian example could be instructive for them in terms of policy lessons. 
  • Pervasive staff shortages in the West and initiatives such as ‘Heal in India’ could accelerate the medical brain drain even as we suffer major staff shortages of our own.
• Need of Private sector participation:
  • The public sector cannot be the only solution for universal health coverage in India. 
  • Expanding PFHIs would entail bringing a large chunk of the private sector under the public fold. 
  • Multifaceted nature of modern health challenges require multilateral and synergistic coalitions involving both the public and private sectors.
• WHO’s recommendations:
  • To build back better, WHO’s recommendation is to reorient health systems using a primary health care (PHC) approach. 
  • Most (90%) of essential UHC interventions can be delivered through a PHC approach, potentially saving 60 million lives and increasing average global life expectancy by 3.7 years by 2030.

Way ahead

• It will be imperative that national interests don’t lose ground to international ambitions and that digital technologies are leveraged to create non-competing solutions that are mindful of the Global South.
• Countries need to build on their existing systems, overlaying reforms and best practices incrementally.
• With concerted efforts and a commitment to excellence, a healthier and more prosperous India can be built for generations to come.