Source: Hindu
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Achieving Universal Health Coverage (UHC) in India—a country marked by vast socio-economic, cultural and regional diversity—is challenging due to its complex healthcare systems and varying local health profiles.
Universal Health Coverage (UHC) aims to ensure that all individuals and communities receive the health services they need without financial hardship.
Access to Care: Timely access to necessary health services.
Quality Services: Effective, safe, and reliable care.
Financial Protection: Avoidance of economic strain due to medical expenses.
Achieving UHC is a key goal under the 2030 Sustainable Development Goals (SDGs).
Directive Principles: Articles 39(e), 42 and 47 direct the state to ensure public health, nutrition and humane work conditions.
Local Bodies: Article 243G empowers panchayats and municipalities to enhance public health.
National Health Policy (1983): Emphasized “Health for All” and equitable healthcare.
Ayushman Bharat (PM-JAY): World’s largest publicly financed health insurance scheme covering over 500 million individuals.
National Rural Health Mission (NRHM): Strengthened rural healthcare with a focus on maternal and child health, immunization, and nutrition.
National Health Policy (2017): Reinforced UHC goals through primary and preventive healthcare.
High Out-of-Pocket Expenditure: Over 40% of healthcare costs are borne directly by citizens pushing over 60 million into poverty annually.
COVID-19 Impact: Highlighted the necessity for robust healthcare systems.
Coordination Issues: Multiple schemes with limited integration lead to inefficiencies.
Preventive Health Focus: Early detection and management reduce chronic disease burden.
India exhibits various healthcare models with significant regional variations.
Some states combine public and private systems while others lean heavily on one type.
For instance Kerala has a strong public health system while states like Bihar depend more on private healthcare providers.
Per capita government spending on health varies significantly as noted in the National Health Accounts (NHA) Estimates for India (2019-20):
Himachal Pradesh: ₹3,829
Kerala: ₹2,590
Tamil Nadu: ₹2,039
Uttar Pradesh: ₹951
Bihar: ₹701
Fertility rates and teenage pregnancies vary widely across states. The National Family Health Survey (NFHS-5, 2019-2021) highlights:
Kerala: Teenage pregnancy rate 2.4%; fertility rate 1.8
West Bengal: Teenage pregnancy rate 16%; fertility rate 1.6
These contrasts underscore the need for tailored UHC approaches for different states.
A significant proportion of healthcare costs are borne by individuals. According to the NHA (2019-20):
West Bengal: OOPE 67%
Andhra Pradesh: OOPE 64%
Despite increased government spending OOPE remains high due to systemic inefficiencies and limited access to free public healthcare.
Increased funding alone does not address systemic design flaws. For example: High C-section rates in public hospitals of West Bengal indicate a sufficient supply of public hospitals yet schemes like Swasthya Sathi channel resources to private hospitals unnecessarily.
This suggests a mismatch between healthcare supply and the intended objectives of public health schemes.
Non-communicable diseases (NCDs) present unique challenges across states. The Indian Council of Medical Research (ICMR) data highlights:
West Bengal: High rates of genetically inherited insulin insufficiency (high diabetes prevalence) but relatively low hypertension rates.
Kerala and Tamil Nadu: Both high diabetes and hypertension prevalence.
Such variations necessitate region-specific health strategies and tailored public health messaging.
Primary healthcare infrastructure is inadequate in many states. According to the Rural Health Statistics (2020-21):
West Bengal faces a 58% shortfall in Primary Health Centres (PHCs) and Health and Wellness Centres (HWCs).
This limits access to early diagnosis, preventive care and management of chronic conditions like diabetes.
UHC must adapt to the unique health challenges of each state. For example:
Addressing insulin insufficiency in West Bengal requires a focus on diabetes care at PHCs.
Kerala’s dual burden of diabetes and hypertension calls for integrated NCD management programs.
Bridging infrastructure gaps is essential. Investments should prioritize:
Setting up new PHCs and HWCs.
Ensuring adequate staffing and equipment for these centers to provide preventive and curative services.
Transition from OOPE-driven healthcare to government-financed systems.
Utilize existing public hospitals effectively instead of relying on private healthcare schemes.
Financial and administrative support must target states with low healthcare spending to ensure equity.
Tailored policies can help bring parity in healthcare access across states.
Integrate public health initiatives with regional adaptations to address state-specific challenges.
Consider socio-cultural and historical contexts to design effective interventions.
Address the impact of climate change on disease patterns and healthcare infrastructure.
Strengthen surveillance and response systems for emerging health threats.
Digital health tools like telemedicine and electronic health records can bridge gaps in rural and underserved areas.
Expand access to healthcare through mobile health units and online platforms.
Promote health literacy through campaigns targeting lifestyle-related diseases like diabetes and hypertension.
Empower local communities to participate in health system governance.
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PRACTICE QUESTION Q.What are the major challenges in achieving Universal Health Coverage (UHC) in India? Critically analyze how these challenges can be overcome. 250 Words. |
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