Implementing universal health coverage

• Universal health coverage (UHC) signifies universal accessibility to comprehensive, high-quality health services, without financial hardship.
• UHC ensures that people receive care whenever and where ever they need it.
• It covers the full continuum of essential health services, from health promotion to prevention, treatment, rehabilitation, and palliative care.

Key highlights

• On December, 12, 2012, the UN General Assembly unanimously endorsed a resolution urging countries to accelerate progress towards UHC.
• In India, the high level expert group report, submitted to the Planning Commission in 2011, outlined a government intent to increase public financing for health to 2.5% of India’s GDP during the 12th Plan (2012-17).
• The economic growth of the country makes this increase feasible.
• The National Health Policy, 2017 articulates “the attainment of the highest possible level of good health and well-being, as its goal, which aligns with the UHC target.

Right to health

• India lacks a constitutional provision for the fundamental right to basic health.
• However, the Directive Principles of State Policy in Part IV of the Constitution provides a basis for the right to health.
• Article 39 (e) of the Constitution directs the state to secure the health of workers;
• Article 42 emphasises just and humane conditions of work and maternity relief; and
• Article 47 casts a duty on the state to raise the nutrition levels and standard of living, and to improve public health.
• The Constitution not only mandates the state to enhance public health but also endows the panchayats and municipalities to strengthen public health under Article 243G.
• Given that health is a state subject and the UHC policy is envisaged at the national level, there is a need for discourses on implementation.
• India has a large migrant population: the total number of inter-State migrant workers was about 41 million (Census 2011), and the total migration rate was 28.9% (Periodic Labour Force Survey, 2020-21).
• With 49% of the population living in urban slums, according to UN-Habitat/World Bank, the focus should be on ensuring the availability and accessibility of primary health services.
• The two critical components of the UHC policy - strengthening primary healthcare and reducing out-of-pocket expenditure - demand focused attention.
• To align electoral mandates with UHC implementation, political leaders should consider the following suggestions.

Suggestions

• To simplify the reimbursement processes for reducing out-of-pocket expenditure.
• The design of cash transfers and reimbursement in India’s public healthcare system needs adaptation for migrant and marginalised communities.
• We need to integrate health management information system dashboards with both public and private systems and ensure better information systems considering language barriers and diversity in the urban context.
• To implement community-based primary healthcare in urban and peri-urban areas with seamless referral systems.
• We need to foster integration of services at the primary healthcare level, ensuring follow-up and adherence to healthcare.