- Prelims: Current events of national importance, Ayushman Bharat Digital Mission, UPI, CoWIN, Aarogya Setu etc
- Mains GS Paper I & II: Development and management of social sectors/services related to Health and education etc
ARTICLE HIGHLIGHTS
- Health as a basic human right, which India’s Constitution guarantees under right to life
INSIGHTS ON THE ISSUE
Context
Health:(WHO)
- A certain totality of health to the realms of mental and social well-being and happiness beyond physical fitness, and an absence of disease and disability.
- We cannot achieve health in its wider definition without addressing health determinants.
Health for All by 2000:
- It was proposed by Halfdan Mahler and endorsed by the World Health Assembly in 1977.
- It had an inherent implication, i.e., “for All”, which means universalisation.
- Nobody is denied this and everybody is eligible without being discriminated against on the basis of financial status, gender, race, place of residence, affordability to pay or any other factors.
- Universal Health Care/coverage (UHC) was implied in 1977.
- India: National Health Policy 1983, committed itself to the ‘Health for All’ goal by 2000.
A focus on primary care
- The International Conference on Primary Health Care(Alma Ata, 1978):
- It listed eight components of minimum care for all citizens.
- It mandated all health promotion activities, and the prevention of diseases including vaccinations and treatment of minor illnesses and accidents to be free for all using government resources, especially for the poor.
- Any non-communicable disease, chronic disease including mental illnesses, and its investigations and treatment were almost excluded from primary health care.
Issues in Secondary and tertiary care:
- It was left to the individual to either seek it from a limited number of public hospitals or from the private sector by paying from their own pockets.
- There were not enough government-run institutions for the poor (who cannot afford exploitative and expensive private care).
- Abdication of responsibility, i.e., to provide secondary or tertiary care by the state, ensured the dominant, unregulated, profit-making private sector and also health insurance sector were kept happy and thriving.
- Dichotomy between peripheral primary and institutional-referred specialist care at the secondary and tertiary levels.
Steps taken:
- Primary Health Care (PHC) Version 2 or Comprehensive PHC was defined.
- National Rural Health Mission (NRHM) in India from 2013.
- Operationalisation of the Health and Wellness Centre as a model of implementation of Comprehensive Primary Health Care.
What needs to be done?
- The Universal Health Coverage slogan must be avoided as it is deceptive.
- This is because it is neither universal in its implementation nor comprehensive in its coverage of services
- It never assures accessibility or affordability as its financing is conditional to insurance premiums paid either by the individual or state.
- WHO should not have yielded to the World Bank and the Rockefeller Foundation during the period of 2004-2010 towards pro-market driven reform guidelines such as reducing state regulation and selectivity of uneconomical service coverages.
- This backtrack from “Health For All” dilutes the UHC concept.
The Astana declaration of 2018:
- This declaration is meant to take the earlier agreement forward, strengthen the primary healthcare (PHC) systems and realize the idea of universal healthcare (UHC).
- It calls for “partnership” with the private sector, though alcohol, tobacco, ultra-processed foods, and industrial and automobile pollution contributed by the commercial private sector are well established.
Issues:
- Poorer countries miserably fail or are unwilling for “private sector regulation”.
- It never addressed poverty, unemployment and poor livelihood.
- It eulogizes quality PHC only as the cornerstone for Universal Health Coverage and ignores broader Universal Health Care.
Ayushman Bharat Digital Mission:
Salient features:
Way Forward
- There is a need for an intersectoral convergence beyond medical and health departments such as women and child development, food and nutrition, agriculture and animal husbandry, civil supplies, rural water supply and sanitation, social welfare, tribal welfare, education, forestry.
- Every individual has a right to be healed and not have complications, disability and death.
- The right is guaranteed only by individualism in public health, the new global approach to UHC, where “nobody is left uncounted and uncared for”.
- The Alma Ata declaration of primary health care can be left behind as a beautiful edifice of past concepts.
- Let us move forward with a newer concept of UHC which encompasses primary, secondary and tertiary care for all who need it at affordable cost without discrimination.
- World Health Assembly resolution of 2011: It urges countries for timely finance of the health sector to reduce out-of-pocket expenses and a catastrophic expenditure in health resulting in the impoverishment of families.
- A globally accepted health systems concept since the Beijing Health Systems Research Conference 2012 is that of a multi-nodal system of varied sectors, professional streams and specialities with a variety of staff to deliver Comprehensive Universal Health Care.
- The National Health Mission with concurrent intersectoral thrusts on Poshan Abhiyan, National Food Security, the Mahatma Gandhi National Rural Employment Guarantee Act, water sanitation, Sarva Shiksha Abhiyan, is a better model of fully tax-funded Universal Health Care.
QUESTION FOR PRACTICE
Besides being a moral imperative of the Welfare State, primary health structure is a necessary precondition for sustainable development.” Analyze.(UPSC 2021) (200 WORDS, 10 MARKS)
