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April 10, 2017

Essay - Universal Health Coverage (UHC)

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Universal Health Coverage (UHC)

  • What is UHC ?
  • India is committed to provide UHC to all under the 12th Five Year Plan period (2012-17).
  • The Government of India launched different programmes, like 'National Rural Health Mission', 'National Urban Health Mission'. 
  • A draft of National Health Policy was introduced in 2015. 
  • UHC can help to do away the health inequalities.
  • The Central Government should monitor the implementation and execution of the funds for healthcare.
  • Some recommendations to accelerate progress of UHC.
Universal Health Coverage' is a scenario in which all the citizens, regardless of their caste, creed, social and economic status, have an access to quality and affordable healthcare services. UHC assumes greater significance in the context of the United Nations' 2030 agenda for Sustainable Development Goals (SDGs) which aim at health for all. UHC day is observed on 12th December every year.

India is committed to provide Universal Health Coverage to all its citizens during the 12th Five Year Plan period (2012- 2017). Its UHC programme is based on the ten principles of universality, equity, non-exclusion and discrimination, rational and good quality comprehensive care, financial protection, protection of parents' rights, consolidated and strengthened public health provisioning, accountability and transparency, community participation and putting health in people's hand. The government will recruit and train a large number of community health workers such as, nurses, rural healthcare practitioners, allopathic doctors, allied health care professionals.

This trained and equipped work force will be available to provide services at public and private facilities. In order to avail the services, one needs to be registered with UHC and each registered person will be issued an IT-enabled National Health Entitlement Card (NHEC) to ensure cashless services. The citizens are free to choose between public sector facilities and contracted in-private providers. They have access to the national health package which will cover free-of-charge all primary, secondary and some tertiary services. The National Health Regulatory and Development Authority (NHRDA) will regulate and monitor the public and private sector players functioning under the UHC. The Government of India will pay for all the services offered under UHC with the help of funds generated from the taxes.

There was a time when the medical expenses were soaring, digging deep holes in the pocket, and the basic healthcare was inaccessible to the people of our country.

The growing discontent against the access, affordability, and quality of the healthcare catalysed a paradigm shift in the healthcare sector of our country. While the citizens were struggling with the rising medical expenses, the government decided to intervene with a host of reforms. The government had also realised the importance of health, as well as healthy individuals, in the economic development, and hence, was keen on providing quality healthcare services to its people.

The first step in this direction came with the launch of India's flagship `National Rural Health Mission' in 2005. This programme was launched with the focus on maternal and child health care and aimed at reducing the mortality in women and their newborns. There were a large number of rural health care activists involved in this programme. The government was successful in generating awareness among the masses regarding the delivery to be done at proper health care centres and importance of immunisation for the young ones.

This was followed by programmes such as 'National Health Insurance Policy' and 'National Urban Health Mission' to name a few. The Rashtriya Swasthya Bima Yojna' aimed at providing financial protection to the population living Below Poverty Line (BPL). This scheme also covers the cost of secondary treatment. Besides, the states have also come up with specific schemes targeting the healthcare, in order to reduce the financial burden on the patients and promote the use of public healthcare facilities. The Community Health Insurance Scheme launched by the Karuna Trust in Karnataka is one such initiative. At present, the 'National Rural Health Mission' and 'National Urban Health Mission' are subsumed under `National Health Mission'.

A high level expert group on Universal Health Coverage recommended the increase in public financing from 1% of the GDP to at least 2.5% along with some major reforms in the healthcare sector. The recommendations of the group were not taken into consideration due to the slowdown in the economic growth of the country. However, a draft of National Health Policy was introduced in 2015 which addressed the need of improvement in the performance of health sector. The draft provides a two way linkage between health and the economic development of the country. It emphasised on the importance and role of public-private partnerships in providing a comprehensive and affordable healthcare benefits to the people. The policy is yet to be implemented.

While such initiatives provide financial coverage to an extent, there are still a large number of people who fall prey to poverty after their illness. Even in the current scenario, the out-of-pocket expenses with regards to the healthcare sector are high, which create health inequities. Non-Communicable Diseases (NCDs) or the lifestyle diseases are the latest addition to the list of healthcare challenges which India has to deal with. Cancer, cardiovascular problems and chronic respiratory diseases are some of the common NCDs. In order to sustain the economic development of our country, health is one of the most important factors. This is where UHC will have an important role to play.

India needs to clearly define its goals and mission in its journey to achieve the UHC target by 2030. This mission needs to be executed in a phased manner. Different states in the country require a different degree of attention and action. Each state can be given a specific target to be achieved in a particular time period. The Central Government should restrict its function to the provision of funds and the overall monitoring of the implementation and execution. A considerable percentage of the funds allocated to the development of healthcare sector are not properly utilised. The government needs to plug in the loopholes and ensure the proper utilisation of these funds.

The factors such as working conditions of the government employees, training of the rural sector workers, creating a functional referral system must be taken into consideration. The government needs to narrow down some key performance indicators which can be used to regularly monitor and evaluate the progress of the UHC programme. The successful implementation of UHC requires a high-level of political commitment both at the centre and state level. Besides, NGOs, private sector players and the government's think tanks have an important role to play in the successful implementation of the project. They need to advocate and create awareness about UHC.

Some recommendations of accelerating progress towards UHC.
  • India must agree to define a vision. This involves agreeing on a process for developing such a vision and goals for 2030. 
  • Opportunities to accelerate UHC in states. States could choose a model that they can follow for 5-10 years to develop their own path and determine their own pace. 
  • High level political commitment beyond the Health Ministry is required. 
  • Along with political commitment, community involvement is equally important for moving UHC. 
  • It is imperative to strengthen government health facilities and improve the working condition of government health staff, especially is rural areas.
India can boast of the remarkable achievements in the healthcare sector such as eradication of polio, maternal and neonatal tetanus etc to name a few. India's achievements in the past definitely prove its capabilities, and assure that it will be successful in the execution and implementation of the UHC programme.

Difficult Words with Meanings :
  • Transparency clearness, clarity
  • Equipped provide or supply
  • Tertiary third in order or level
  • Inaccessible unapproachable
  • Paradigm a typical example
  • Intervene come between so as to prevent or alter something
  • Do away with abolish, discard
  • Implementation execution, application.
shared by Nisheeta Mirchandani
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