International Universal Health Coverage Day 2019: What India needs

Today, 12 December, is International Universal Health Coverage Day. The message of the movement is that “every person, no matter who they are, should be able to get the quality of health services they need without facing financial hardship”. The United Nations first started celebrating this day on a global scale in 2017 after lobbying by the UHC Coalition, an organization of advocates and policymakers which was already using the day to spread awareness about UHC, albeit to a smaller audience. [caption id=“attachment_4446977” align=“alignleft” width=“380”]  Representational image. Reuters[/caption] The theme for this year’s celebration is “Keep the promise”, a reference to the UN High-Level Meeting on Universal Health Coverage that took place earlier this year, where various stakeholders such as heads of state, health ministers, policymakers and health leaders pledged universal health coverage (UHC) in their respective countries by 2030. Earlier this year, when the WHO scored countries based on their universal healthcare coverage, India scored 55 out of 100. Universal health coverage is a humungous goal in India, where the cost of healthcare and lack of infrastructure in many parts can be common hurdles to accessing even the most basic services. Last year, the government merged existing policies and added some new provisions to launch Ayushman Bharat - the poor man’s health insurance. But there is still a long way to go to achieve universal healthcare in India. Here’s a quick look at what it will take to make healthcare accessible to every Indian:

The hope

The international goal of universal healthcare includes some basic criteria. These include:  

• Strengthening primary healthcare centres to reduce the threat from communicable diseases such as HIV/AIDS, tuberculosis and malaria; non-communicable diseases; and antimicrobial resistance.
• Special attention will also be paid to maternal and child health.
• Universal Health Coverage is also being pitched as a universal right rather than a privilege.
• Recent scholarship and political lobbying have also pushed the definition of UHC to go beyond health outcomes by giving it a human development spin; providing educational opportunities, social services and jobs are considered crucial to overall health.  

Where India stands

The World Health Organization (WHO) 2019 report on Universal Health Coverage highlights some of the progress made over the past decades and the challenges faced by countries in providing quality healthcare. Using a “Service Coverage Index” (SCI) based on four essential health service areas - reproductive, maternal, newborn, and child health; infectious diseases; non-communicable diseases; and service capacity and access - WHO analysed the level and quality of coverage by country. SCI was measured on a scale of 0 to 100, with a higher score indicating greater healthcare coverage. India scored 55 on the SCI indicator. The country performed well on metrics like child immunization at 89% but was let down by overall sanitation (60%) and health worker and hospital density (29% and 36%, respectively). Antiretroviral therapy (for managing HIV/AIDS) was available to only 34% of those who needed it. By comparison, Sri Lanka scored 66 on the scale; Myanmar, 61; China 79; Bangladesh, 48; and Pakistan, 45.  

Lessons from other countries and some Indian states

While schemes like Ayushman Bharat and Poshan Abhiyaan, along with various state initiatives, have produced some encouraging results towards UHC, there is still a lot to be done to ensure healthcare for over a billion Indians. Historically, India’s GDP (gross domestic product) spending on healthcare has been meagre and the proportion of health budget allocated to public health (27%) too low to improve infrastructure in the more remote parts of the country, where people need it the most. A reassessment of priorities is needed to focus attention on investing in the health and wellbeing of the public. Happily, there are some best practices that we can learn from some states, as well as other nations with similar GDP and/or size as us:

• Cuba and Brazil are known to have excellent primary healthcare built on cultural competence and public participation. The Cuban model is based on the community-based polyclinics, each of which provides preventive, promotive and curative care to 15,000-20,000 people. Neighbourhood doctors cater to around 1,000 people and are vital in providing primary care.
• Within India, in West Bengal and Kerala, primary health is co-managed by panchayats. Health indicators are better than the Indian average here; when the public is more involved in dealing with their health, outcomes are better.
• According to the WHO report, primary healthcare is insufficient in India as it does not reach many people. Hospitals are understaffed and the infrastructure is poor; often there is no electricity or water and there is also a shortage of medical supplies. In states such as Madhya Pradesh, Bihar and Jharkhand some primary health centres cater to over 70,000 people each. Cuba and Brazil performed better on this metric. Strengthening infrastructure in this section might be the key to empowering a currently disenfranchised population and promoting their overall health and development.  

Interactivity

The International Universal Health Coverage Day website has a “toolkit” to help spread the word. This includes a draft letter addressed to your local healthcare representative. The idea is to empower citizens, to sign and share the letter on social media - and potentially be heard by the concerned policymakers. For more information, please read our article on   HIV/AIDS: Stages, Symptoms, Prevention and Treatment_. _  Health articles in Firstpost are written by myUpchar.com, India’s first and biggest resource for verified medical information. At myUpchar, researchers and journalists work with doctors to bring you information on all things health.