Context

India’s aspiration to achieve economic development by 2047 is deeply tied to the health of its population. A robust health system must be prioritized to ensure a healthy and productive workforce.

Universal Health Coverage (UHC)

Universal Health Coverage (UHC) ensures that all individuals and communities receive essential health services without financial hardship. Achieving UHC is a fundamental goal under the 2030 Sustainable Development Goals (SDGs).

Key Components of Universal Health Coverage (UHC)

• Access to Care: Timely access to essential health services.
• Quality Services: Effective, safe and reliable healthcare delivery.
• Financial Protection: Protecting individuals from economic hardship due to healthcare expenses.

Universal Health Coverage in India

Constitutional Backing

• Directive Principles of State Policy:
  • • Article 39(e): Safeguards the health of workers.
    • Article 42: Ensures just and humane working conditions and maternity relief.
    • Article 47: Directs the State to improve public health and nutrition.
• Local Governance: Article 243G empowers Panchayati Raj Institutions and Municipalities to improve public health.

Policies and Programs

• National Health Policy (1983): Advocated for “Health for All” through equitable and accessible healthcare.
• Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (PM-JAY): The world's largest 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 emphasis on primary and preventive care.

Why Universal Health Coverage is Critical for India

• High Out-of-Pocket Expenditure (OOPE): More than 40% of healthcare costs are directly borne by citizens, pushing over 60 million people into poverty annually.
• Fragmented Schemes: Lack of integration among multiple government programs results in inefficiencies.
• Preventive Healthcare: Early interventions reduce chronic disease burdens.

India's Healthcare

Regional Disparities in Government Spending
Per capita health expenditure varies significantly among states:

• Himachal Pradesh: ₹3,829
• Kerala: ₹2,590
• Tamil Nadu: ₹2,039
• Uttar Pradesh: ₹951
• Bihar: ₹701

Health Outcomes and Regional Variations

• Teenage pregnancy rates and fertility rates vary, e.g., Kerala has a teenage pregnancy rate of 2.4% and fertility rate of 1.8, while West Bengal reports a teenage pregnancy rate of 16% and fertility rate of 1.6 (National Family Health Survey-5, 2019-2021).

 Primary Healthcare Gaps

• Infrastructure shortages, such as 58% shortfall in Primary Health Centres (PHCs) and Health and Wellness Centres (HWCs) in West Bengal, hinder early diagnosis and preventive care.

 Non-Communicable Diseases (NCDs)

• State-specific challenges, e.g., high prevalence of diabetes in West Bengal and dual burdens of diabetes and hypertension in Kerala and Tamil Nadu, highlight the need for targeted interventions.

Challenges to Achieving Universal Health Coverage

High Out-of-Pocket Expenditure (OOPE)

• OOPE remains high despite increased public spending, e.g., West Bengal and Andhra Pradesh report OOPE of 67% and 64% respectively (National Health Accounts, 2019-2020).

Design Flaws in Healthcare Systems

• Misaligned resources, such as channeling funds to private hospitals despite adequate public infrastructure, e.g., high caesarean section rates in public hospitals of West Bengal.

Diverse Health Profiles

• Varying disease patterns, such as insulin insufficiency in West Bengal and dual NCD burdens in Kerala, demand state-specific strategies.

Lessons and Way Forward

Region-Specific Strategies

• Tailor interventions to state-specific needs:
  • • Address diabetes management in West Bengal.
    • Implement integrated NCD care programs in Kerala.

Strengthening Primary Healthcare

• Invest in setting up PHCs and HWCs with adequate resources to enhance preventive and curative care.

Reducing Out-of-Pocket Expenditure (OOPE)

• Transition from OOPE-driven models to government-financed systems.
• Optimize the use of public hospitals over private healthcare schemes.

Addressing Inequities

• Financial and administrative support to states with lower healthcare spending to ensure equitable access.

Leveraging Technology

• Expand telemedicine, electronic health records and mobile health platforms to bridge rural-urban gaps.

Community Engagement

• Promote health literacy and involve local communities in healthcare governance to strengthen public participation.

Building Climate-Resilient Systems

• Develop infrastructure and surveillance mechanisms to address climate-induced health challenges.

Universal Health Coverage (UHC) represents a comprehensive and equitable approach to healthcare, ensuring a healthier and more resilient India.

ANALYSIS OF EDITORIAL

Primary Healthcare-Led Universal Health Coverage (UHC)

• UHC as a Priority: Achieving UHC requires higher public financing and resource allocation.
• Indicators of Success: Focus on financial protection and service coverage.
• Multi-Skilled Workforce: Immediate steps include training technology-enabled frontline health workers and allied health professionals.

Ayushman Bharat Mission: A Key Driver

• Key Components: Upgraded primary care, health infrastructure, financial protection and a digital health technology thrust.
• Integration is Critical: These components must work together to create a strong healthcare engine.

Harnessing Digital Strengths for Healthcare

• Digital Health Mission: Aims to bridge gaps between primary care and insurance programs like PMJAY.
• Data Integration: Public and private sector data must be interconnected to create digital data banks.
• AI Applications: Leveraging AI for diagnostics and clinical management.

The Importance of Disaggregated Data

• Regional Variability: Health indicators vary across districts, states and socio-demographic groups.
• Integrated Data Systems: Transform disparate data into timely, representative and accurate insights.
• Accelerating Epidemiological Transition: Address the dual burden of non-communicable diseases (NCDs) and infectious diseases.

Innovative Surveillance Systems

• Comprehensive Monitoring: Real-time surveillance for infectious diseases, zoonotic diseases and AMR.
• Techniques like Wastewater Surveillance: Early detection of microbial threats.
• Climate Change Impact: Monitor the rise in water-borne and vector-borne diseases.
• The "One Health" Approach: Integrate surveillance across species and geographies.

Challenges in Patient Care

• Data Disconnects: Lack of integration hampers diagnostic assessments and treatment decisions.
• Rights to Information: Patients deserve comprehensive access to their health records.

Bridging Public and Private Healthcare Gaps

• Uneven Adoption: Private healthcare must align with digital health initiatives.
• Unified Systems: Connecting public and private data can ensure affordable and effective healthcare.

Community Participation in Digital Health

• Crowdsourced Data: Engage communities to report outbreaks and system inefficiencies.
• Digitally Enabled Transformation: Drive a digitally assisted health revolution in 2025.

Conclusion

India’s journey to a healthy and economically developed nation by 2047 depends on a robust, digitally integrated healthcare system. With a focus on universal health coverage, digital innovation and community engagement, the foundation for a healthy Bharat can be laid in 2025.

Source:

Indian Express