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Insights into Editorial: Achieving universal health coverage in India
The World Health Organization (WHO) Health Assembly set the target of “Health for All” in May 1977. These were to be achieved by the end of 2000. Subsequently, in 2000, the Millennium Development Goals were formulated by the UN with the target for achievement set for 2015. This was followed by the Sustainable Development Goals (SDG), set by the UN in 2016, to be achieved by 2030 by all member countries.
In fact, Recently happened 71st World Health Assembly in Geneva deliberated on the importance of environmental, climate and other determinants of health. Known avoidable environmental risk factors cause at least 13 million deaths every year and about one quarter of the global burden of disease.
What are the major problems of Health sector in India?
After the independence the focus has been increased significantly on Health status of people. As a result, there has been a significant increase in life expectancy of people from 35 years to 65 years.
However, it is unevenly distributed in different parts of the country. The health problems in India are still a cause of concern.
As the income levels of the people have increased there is spurt in non-communicable or life style diseases which accounted for nearly half of the deaths.
The existing healthcare infrastructure is just not enough to meet the needs of the population. The central and state governments do offer universal healthcare services and free treatment and essential drugs at government hospitals.
However, the hospitals are understaffed and under-financed. People living below poverty line continue to rely on insufficient health care facilities in rural areas.
India has one of the lowest per capita healthcare expenditures in the world. The high out-of-pocket expenses in India stem from the fact that majority of Indians do not have health insurance.
Moreover, majority of the skilled health care professionals happen to be concentrated in urban areas. This is the main reason for rural- urban disparity in terms of healthcare.
Healthcare challenges in India:
- The country’s diversity in terms of geography, culture, and demography
- Political system
- Unsafe boundaries
- Huge population burden
- Poor investment in health
Changing the behaviour pattern of the Indian masses, including the patient population, is something which has been focused upon much yet.
Access to readily reachable, trustworthy and affordable health care is a major challenge before poorly served rural areas and overcrowded urban areas.
Also, the inadequacy of organised primary health services here is compounded by a weakness at the intermediate level of care in many district hospitals and nursing homes.
While corporate hospitals boast of high quality advanced care and compete with each other for a significant share of medical tourism, they are mostly inaccessible to the rural population and the urban poor. Government institutions of advanced care suffer from low budgets and a lack of managerial talent.
Importance of Universal Health Coverage in India:
The health goal under the United Nations Sustainable Development Goals is, arguably, the most important target on the agenda of India and other member countries because of its inextricable connection with other indicators of socio-economic development like poverty, zero hunger (nutrition), quality education, gender equality, clean water and sanitation. The essence of this goal is to “ensure healthy lives and promote well-being for all in all ages”, which implies universal health coverage.
Definition of Health and well-being:
A determinant-based definition of health and well-being will not only help in better perception of disease, but also provide a better tool in deciding the right priority for public health interventions.
Diseases of public health importance, such as kala azar, lymphatic filariasis, leprosy, etc., can manifest in an apparently healthy population in tropical and sub-tropical climatic regions and can re-emerge if not eliminated.
While there has been tremendous progress in addressing neglected tropical diseases in many countries, including India, due to concerted efforts of the government, elimination efforts are still to be universalized across many districts.
These diseases shouldn’t be neglected any more, even though the magnitude of reported cases has reduced over the years. The countries affected by neglected tropical diseases must intensify efforts to achieve elimination that is validated and universal care for disabled persons.
Need to redefine the definition of Health:
Viewed through this holistic lens, the revised definition of health should include all such determinants and be redefined as “a state of complete physical, mental, social and environmental well-being, including absence of determinants of disease in the body or in its proximity that can cause harm by use or by contact with the body”.
Making private practitioners an important part of the public healthcare:
It is counterproductive to insist that private practitioners should not be an integral part of the overall government effort to provide good healthcare to people.
Such an insistence makes the notion of maintaining disease-specific countrywide registers in which individual doctors and hospitals participate almost impossible.
A truly universal healthcare system is driven by protocols that care for the patient and integrate all practitioners. Once such a system is put in place along with regular reporting, the distinction between private and public becomes meaningless.
To successfully put care and quality back into healthcare, it is important to set up this kind of system to track the health status of patients. This will help remove smoothen the public-private healthcare debate.
It is high time for UN bodies/World Health Assembly to acknowledge the need for redefining health in light of the SDGs.
Universal health coverage should be designed based on the revised definition of health. That will lead to a better understanding, and attainment, of holistic health and well-being. This will help in directing focused priority and mobilization of resources in the right direction.
In addition, a National framework for universal health coverage needs to be developed by the member countries. This would involve inter-sectoral collaborations at the community level with local health teams, the private sector, non-government organizations and community-based organizations to strengthen primary health and support secondary and tertiary infrastructure.
This would not only ensure proper and complete treatment but also empower people to protect themselves from illness and encourage treatment-seeking behaviour for which people’s awareness needs to be built up through simple community-level ideas for health promotion, prevention and self-protection as essential part of primary healthcare.
Joint participation with health teams by trained volunteers in uniform, including those from National Cadet Corps (NCC), National Scout Services (NSS), nursing schools, etc., can provide a thrust for addressing social, and environmental determinants and can bring about positive change in personal hygiene, healthy behaviour and cleanliness. Approaching healthcare policies from the behavioural angle can ensure better systemic efficiency and large-scale transformation.
History is full of examples of governments empowering their people to propagate a holistic approach to what we now term universal health coverage. In the third century BC, emperor Ashoka is believed to have said, “I am going to propagate medicinal herbs throughout my kingdom to ensure complete accessibility to all my subjects as it is my ethical responsibility to provide good health to all people.”
It is time, clearly then, to let history repeat itself.