On 25th September 2015, World leaders met at the United Nations in New York to adopt the 2030 Agenda for Sustainable Development. One of the key resolutions discussed at the summit was the adoption of Universal Health Coverage for eliminating poverty and building a more resilient planet. Since then, the world forces are working relentlessly to enable UHC and commit to concrete steps to advance the health of all people. In WHO’s 70th anniversary year, therefore, World Health Day (7th April 2018) is focusing on “Universal health coverage: everyone, everywhere” – ensuring that everyone, everywhere can access essential quality health services without facing financial hardship. This is a heartening resolution for sure. But, in the face of rising medical costs and flagging medical infrastructure in most of modern India, the question remains – can India achieve Universal Health Coverage by 2030?
The Situation in India today
On the global front, a recent ranking of 166 health systems on outcomes and spending placed India in the bottom quintile, way behind economies with similar levels of income per capita and economic development (The Economist Intelligence Unit 2014).
India has one of the world’s lowest public spending on health (1.2% of GDP). But, while the discussion often gets derailed on the financial aspect, economists believe that money is not an obstacle to India’s UHC status.
India’s Ministry of Health has estimated that rolling out UHC will cost approximately $6.5 billion per year for four years (2015-19). India’s current GDP is estimated at $2.25 trillion by the World Bank. Consequently, the cost of rolling out UHC is actually only 0.28% of India’s GDP and well within the country’s public health expenditure.(1)
The real problem in implementing UHC in India is the lack of efficiency and the non-availability of the right financial and service delivery model applicable to India. In the absence of citizen demand for UHC, the agenda for healthcare in India is being set by Industry Syndicates and the rapidly expanding health-care industry is not very excited about the implementation of health policies in public interest.
So, in a nutshell the Private players have no incentive to enable Universal Healthcare in India, and the Public players don’t have the strength or ability to do so.
The Effort Underway
India was a latecomer to the UHC party, with the first health-related reforms happening as late as 2005 when the NHRM was launched. It provides funding and a policy framework for building rural health infrastructure.
In a major step towards providing Universal Health Coverage – a promise made by Narendra Modi government – finance minister Arun Jaitley in the Budget announced a National Health Protection Scheme (NHPS) providing Rs 5 lakh health insurance to 10 crore poor families. Of course, like almost all schemes announced by the current government, the implementation of the same remains a huge concern.
More importantly, is the increased focus on health insurance the right way for India? The development of new health insurance schemes, as is the approach in many Western UHC models, seems moot in India, since for most of the population the nearest health center is impractically distant. Most rural patients in India die before they see the inside of a health center or the face of a doctor. I remember meeting a bunch of women in a village in Jharkhand some years back, who said that they were afraid of dying of childbirth more than anything else because the nearest hospital was 135kms away. In the face of that problem, how will more insurance be of any assistance?
What can be done to pave the way for UHC in India(2)
India’s National Rural Health Mission, now known as National Health Mission, is doing a decent (albeit slow) job of infrastructure development with the State Governments. It is time that India considers giving this body the Constitutional Right to be the custodian of health in the country. Health also needs to be given the status of a Constitutional Right for citizens.
India also needs to refocus its attention on the building of a general health system, instead of focusing entirely on vertical programs like HIV, Polio, or Tuberculosis.
India could also look at building a ‘gatekeeping tertiary healthcare system’ that has a robust referral system to feed into the private primary care. India is in desperate need of a sharply defined Public-Private-Partnership scheme in healthcare, that marries the shooting capabilities of India’s private health sector with its growing demand for rural healthcare, keeping an eye on abuse of the system by greedy private players.
According to WHO, access to essential quality care and financial protection not only enhances people’s health and life expectancy, it also protects countries from epidemics, reduces poverty and the risk of hunger, creates jobs, drives economic growth and enhances gender equality. It is therefore of utmost importance that India reenergizes its efforts to ensure UHC by 2030 for the economic betterment of the nation.
(1) Achieving universal health coverage in India: Inefficiency is the problem, not money – Dr. Kanchan Mukherjee, TISS Mumbai
(2) India in search of right Universal Health Coverage (UHC) model: The risks of implementing UHC in the absence of a political demand by the citizen – Raman Kumar and Pritam Roy, Journal of Family Medicine and Primary Care