For the economic and social development of a nation, it is crucial that its population is in sound health. Medical costs have hit the roof, and with an efficient health system, countries can provide accessible healthcare through Universal Health Coverage. As defined by the World Health Organization, ‘Universal health coverage (UHC) means that all people and communities can use the promotive, preventive, curative, rehabilitative and palliative health services they need, of sufficient quality to be effective, while also ensuring that the use of these services does not expose the user to financial hardship.’ All United Nations Member States have committed to achieving UHC by 2030 as part of Sustainable Development Goals.
UHC and the Indian Healthcare System
The definition by WHO encapsulates three objectives, equity in access to healthcare services, quality health services to improve the health of those receiving services and protection of people against financial-risk by providing affordable healthcare. Equity in access means that services must be accessible to everybody, not just those that can afford them. India is a diverse country with a large population that needs to accessible healthcare through Universal Health Coverage. The Indian Government has introduced initiatives that can meet the healthcare needs of its citizens.
One of the schemes, The National Health Protection Scheme (Pradhan Mantri Jan Arogya Yojana), that covers over 10 crore underprivileged and vulnerable families providing health coverage up to 5 lakh rupees per family every year, cater to the needs of the population with low financial resources. The Scheme has1.5 lakh health and wellness centres and coverage of almost all secondary and tertiary hospitalizations. The scheme in partnership with the National Institution for Transforming India (NITI) will have a robust IT platform to help facilitate cashless, paperless transactions.
Public-private partnerships (PPP) have also been instrumental in improving accessibility in impoverished regions, for eg, PPP initiatives in healthcare in the tribal areas of Odisha, Janani Express and Maa Gruha schemes brought about a rise in the number of institutional deliveries in the state.
India is a low-resource setting, and the challenge is to provide citizens with high quality in healthcare. The obstacles range from healthcare providers who fail to provide high-quality care, gaps in information in healthcare, lack of accountability among providers, low functioning governance systems, geographic differences in quality of healthcare and high levels of medical errors. This is in contrast to the quality in services available due to global pioneers like Apollo Hospitals, Wockhardt Hospitals, Narayana Hospitals, Aravind Eye Care and All India Institute of Medical Sciences (AIIMS), Fortis Healthcare, etc.
Healthcare Initiatives in India
To ensure quality healthcare, the National Accreditation Board for Hospitals & Healthcare Providers (NABH) was set up in 2006. Hospitals were given a one-year extension in 2018, to register themselves with NABH and comply with their standards. The Hospital Directory was set up to provide healthcare related information like state wise list of hospitals for citizens of India. The National Rural Health Mission (NRHM) was launched in 2005 to provide quality primary healthcare to rural citizens.
Many government health insurance plans can also be availed by citizens, like the Rashtriya Swasthiya Bima Yojana (RSBY), Employment State Insurance Scheme (ESIS), Central Government Health Scheme(CGHS), Universal Health Insurance Scheme (UHIS), Ayushman Bharat, etc. Currently, India spends only 1.2-1.5 percent of its GDP on healthcare and plans to spend about 2.5 percent of the GDP as per its (National Health Policy) on healthcare. It is woefully behind on its goals in comparison to countries like the US and UK that have per capita expenditures of $4,802 and $3,500 respectively.
The NHS in England has set a 10-year long term goal to provide quality healthcare services to the public. Similarly, with the effective implementation of current and new initiatives, people should be protected against financial risk in India by making public healthcare accessible and affordable. There’s a shortage of physicians and specialists in India, with the doctor-population ratio, a dismal 0.62 per 1000 people. A strong primary care system, a renewed health workforce, price transparency for medicinal products, and equitable access is the way forward for UHC in India. The role of doctors is inextricably linked to providing quality UHC in India, and training or upskilling them must be one of the key priorities for Indian healthcare.
As of now, India needs to take larger strides in the direction of UHC as it only spends 1.2 percent of its GDP on healthcare. One of the countries that have achieved UHC is the Philippines, which spends about 4.6 percent of its GDP on healthcare. Government schemes and compulsory contributory health care financing schemes (accounting for about 34.2 percent) in the Philippines lowers the burden of healthcare financing for its citizens. It introduced a National Health Insurance as early as 1995 with PhilHealth. In September 2017, a major political impetus was passed by the House of Representatives, through the Universal Health Coverage Bill. The Philippines government has reiterated the importance of NHI as a tool towards fulfilling UHC, recently in its ‘Philippine Health Agenda 2017–2022′. India can follow in the footsteps of countries like the Philippines and increase the quality of healthcare and introduce initiatives to finance healthcare. It can effectively implement UHC and provide a better life for the people. A good healthcare system will lead to substantial growth in the overall economy and will help make India the next global superpower.
