Answer

In the small village of Vidarbha, Maharashtra, lives Seema, a widow struggling to make ends meet after the untimely death of her husband due to an untreated illness. Seema’s life took a further tragic turn when her son, just seven years old, developed a severe respiratory condition. With no savings and no health insurance, Seema faced an impossible choice: either sell their small piece of land or let her son suffer without proper medical care. Despite her desperate efforts, she couldn’t gather enough money for the treatment, and her son’s condition deteriorated. Seema’s story is a stark reminder of the harsh realities faced by millions in India, where access to healthcare is often determined by one’s financial situation. This raises the critical question: When will universal health coverage become a reality ensuring that no one has to choose between life and livelihood? How will she survive? Does a poor child not have the right to life? Why do people, especially the poor and vulnerable, have to suffer a lot while accessing and affording health services? When will we achieve universal health coverage and affordable health to all?

The concept of universal health coverage is associated with the right to life provided by the Indian constitution (Article 21) and DPSP that secure good living conditions to all. Universal health coverage (UHC) refers to a healthcare system that ensures all individuals, regardless of their socio-economic status, have access to essential healthcare services without suffering financial hardship. Here the concept comes with three A’s- affordability, availability and accessibility. Health coverage must be both affordable and accessible, ensuring that essential services are available at a decentralised level and within reach for everyone, regardless of their socio-economic status. Inclusive access to healthcare for all is the foundation of universal health coverage, which has become an urgent necessity for communities, states, and the nation as a whole.

Universal Health Coverage: A Platform for healthy India

The foremost and most critical benefit of universal health coverage is its ability to vastly improve health outcomes. By ensuring timely and affordable access to healthcare services, nations can drastically lower mortality rates, extend life expectancy, and enhance the overall quality of life for their citizens. According to NITI Aayog data, the availability of timely hospital deliveries can reduce child mortality rates by a staggering 75%. Similarly, for chronic diseases, particularly in rural areas, early and accessible treatment plays a crucial role in significantly improving health outcomes.

Another crucial advantage of universal health coverage is its power to alleviate the crippling financial burden on families. The Bill Gates Foundation highlights that a single hospital admission in rural areas can thrust a family into a poverty trap, a harsh reality starkly exposed during the COVID-19 pandemic. This financial strain has devastating ripple effects on every aspect of life. In rural areas, for instance, the crushing weight of healthcare expenses can drive families to the unimaginable—selling their ancestral land to survive. Such a tragic and eye-opening incident underscores the dire need for universal health coverage. Moreover, a study by the Pune Urban Police Department post-COVID-19 revealed a shocking 50% drop in school enrollment in slum areas, indicating that these children are being forced into child labour to make ends meet. This heartbreaking cycle of poverty and exploitation highlights the urgent necessity of ensuring accessible and affordable healthcare for all.

Rising healthcare costs have exacerbated issues of hunger and nutritional security, as impoverished families struggle to afford quality food, falling into the trap of hidden hunger. According to the ICMR, 27% of children in India are affected by hunger-related issues. This underscores the crucial need for universal health coverage, which can free up resources for other essential needs, ultimately contributing to poverty reduction and socio-economic development.

The social dimension of health security is associated with equality and social justice. Martin Luther King says that, “Of all the forms of inequality, injustice in health care is the most shocking and inhuman because it often results in physical death”. As per World Bank, increased health cost has different effects on purchasing parity of different income groups. For instance, poor people suffer more and an extra percentage of daily earnings goes towards fulfilling the health costs. That not only affects the finance but also creates inequality in terms of exclusion. Universal health coverage aims to ensure equitable access to healthcare for all citizens, promoting social justice by eliminating disparities in healthcare outcomes based on socio-economic status, gender, and region. That brings real regional equality and reduces imbalance.

First and foremost, Universal Health Coverage (UHC) significantly enhances the country’s capacity for disease prevention and early diagnosis. By facilitating access to preventive measures, vaccinations, and regular screenings, UHC helps identify health issues at an early stage, leading to more effective treatment and cost savings. For instance, Kerala’s robust healthcare system demonstrates how effective health facilities and preventive care contribute to a low disease burden, evidenced by a low infant mortality rate (6 per 1,000 live births) and low maternal mortality rate (19 per 100,000 live births), with 92% of public health centres operating effectively as per the National Health Mission.

Another crucial advantage of UHC is its provision of financial protection for vulnerable populations. By shielding individuals and families from catastrophic healthcare expenses, UHC reduces the risk of falling into poverty due to unexpected medical costs. According to Dr. Arole’s NGO, implementing universal health coverage could significantly boost savings in the Marathwada region, underscoring the broader economic benefits of comprehensive health coverage.

Universal Health Coverage (UHC) embodies a patient-centred approach, placing individual needs and preferences at the forefront of care. This focus not only enhances patient satisfaction but also leads to improved health outcomes. According to NITI Aayog, India’s low doctor-to-bed ratio and inadequate ambulance services highlight significant gaps in the healthcare system. UHC addresses these issues by ensuring that healthcare is both accessible and affordable for everyone.

Additionally, UHC boosts overall productivity by enabling individuals to maintain better health, thereby increasing their effectiveness in the workforce. This not only enhances personal well-being but also contributes to the nation’s economic growth, as a healthier population drives higher productivity and a more robust health system.

Challenges to Achieving Universal Health Coverage: speed breakers to highway of healthy india campaign

A major constraint in implementing Universal Health Coverage (UHC) in India is securing adequate funding. The National Health Policy emphasises the need for at least 2.5% of GDP to be invested in healthcare. For a country with limited financial resources, allocating sufficient funds to healthcare presents a considerable challenge.

Another significant issue is the management of human resources and the availability of health infrastructure. Expanding healthcare access necessitates a well-developed infrastructure and a sufficient number of trained professionals. Decentralised health systems face several challenges: inadequate building conditions, unreliable electricity, a shortage of doctors willing to work in rural and suburban areas, and intense competition from private hospitals. According to PIB, the urban-to-rural doctor density ratio is 3.8:1, revealing a stark imbalance. Additionally, the scarcity of quality medical colleges exacerbates the uneven distribution of healthcare resources.

Consider the issue of ambulance availability as a critical example. According to the National Rural Health Mission (NRHM), the government has only 6,226 ambulances for rural areas, which is half the number needed. WHO standards recommend at least one ambulance per 100,000 people in flat areas and one per 70,000 people in hilly or tribal regions, where populations are dispersed.

Beyond these infrastructure and resource challenges, the complexities of Indian bureaucracy and governance pose significant obstacles. Corruption in healthcare, which has dire human consequences, undermines efforts to improve health systems. Issues such as corruption in primary health centres, inefficiencies in infrastructure development, and bureaucratic red tape complicate UHC implementation. Addressing these challenges requires administrative reform, effective governance, and robust public-private partnerships to ensure that UHC initiatives are successful and equitable.

In addition to the aforementioned challenges, addressing behavioural and cultural factors in Indian society is crucial. Shifting entrenched behaviour patterns and cultural norms related to healthcare can be particularly challenging. Efforts must focus on education, awareness, and community engagement to drive change. For instance, in Osmanabad district, despite the presence of healthcare infrastructure, traditional beliefs and superstitions lead people to avoid hospitals for deliveries, contributing to high maternal and child mortality rates, as highlighted by the

NITI Aayog’s aspirational district program.

Another assertion that private healthcare offers quicker and more specialised services, and while UHC focuses on accessibility, the quality of care in government-funded systems might not match that of private providers. This could lead to a two-tier system where wealthier citizens opt for private healthcare, leaving the public system overstretched and struggling to deliver high standards of care. Thus, a nuanced approach, rather than blanket universal coverage, may be required to address India’s diverse healthcare needs.

Strategies for Achieving Universal Health Coverage: Healthy india -Happy India

Healthcare should be regarded as a fundamental human right, not merely a commodity. Although challenges are inevitable, they are essential for revealing our true potential. Our civilization progresses by confronting and overcoming these challenges, which is the essence of a resilient, innovative, and thriving society. The first strategic approach is increasing government investment in healthcare. This requires allocating a substantial portion of the budget to Universal Health Coverage (UHC). It may also involve enhancing taxation systems, prioritising health financing, and minimising out-of-pocket expenses. The National Health Policy supports targeted funding, with separate allocations for areas such as doctor training and village-level healthcare administration.

Additionally, India should explore innovative financing mechanisms. Options such as social health insurance, public-private partnerships, and international aid can provide crucial funding for UHC. In Kerala, community-owned financing models are effective, and implementing a health cess could also be a viable solution.

We must focus on strengthening health systems. Leveraging the expertise of civil society organisations, such as Dr. Arole’s Magsaysay Prize-winning NGO, which is making significant strides in regions like Marathwada, can greatly aid this effort. Additionally, investing in health infrastructure is crucial—this includes expanding facilities in underserved areas and enhancing the availability of essential medicines and technologies. Strengthening Gramin Arogya Kendras is particularly urgent.

Moreover, developing a robust and skilled health workforce is essential. The government needs to prioritise the training, recruitment, and retention of healthcare professionals to ensure high-quality service delivery. Initiatives like the Public Health Cadre Management System are steps in the right direction. Furthermore, the Ayushman Bharat scheme is demonstrating remarkable success, providing cashless medical treatments up to ₹5 lakh per family per year for over 1,000 procedures across 30 specialties. This scheme benefits 83.74 lakh families and brings us closer to achieving Universal Health Coverage.

The final crucial aspect of achieving Universal Health Coverage (UHC) is fostering community involvement and raising awareness. Engaging communities and educating individuals about the benefits of UHC can help overcome cultural barriers and improve healthcare uptake. Schools and colleges are key in disseminating this information and driving societal change. For example, the NGO Snehalaya has made significant strides in this area, with successful campaigns on anaemia awareness and HIV protection in urban areas showcasing their impactful work.

Moving forward, Universal Health Coverage (UHC) is essential for any society committed to the well-being of its citizens. By ensuring equitable access to healthcare services, UHC can improve health outcomes, alleviate financial burdens, and foster societal development. While challenges are present, nations can achieve UHC through dedicated efforts, strong policies, and unwavering commitment, paving the way for a healthier future for all.

Universal Health Coverage is not merely an ideal but a necessity for a just and equitable society. It promises to transform healthcare from a luxury for the few into a right for all. By addressing the challenges and implementing effective strategies, India can move closer to a future where no one has to choose between life and livelihood. Seema’s story serves as a powerful reminder of the imperative to ensure that every citizen has access to the healthcare they need to live a healthy and dignified life.

DOWNLOAD PDF