How to approach the Essay? 

❖ Introduction: 

➢ Start with an example that shows the necessity of UHC. 

➢ Explain thesis and topic 

❖ Body 

➢ Answer the following questions in body part: 

➢ Why did we require UHC? 

➢ What are the benefits of UHC? 

➢ Why is India behind providing UHC? 

➢ Sustainable strategies required to Achieve UHC. 

❖ Conclusion 

➢ Write way forward in conclusion. 

Answer: 

It is the story of Kamla, one widow of Marathwada region, who migrated to Mumbai after suicide by her  husband. In Mumbai she was living in Dharavi slum with a 5 year old girl. In 2020 sudden arrival of COVID 19, and infection to her small girl hampered her livelihood. She doesn’t have any savings and any financial  support. Only option remaining with her was to sell everything in the house. Because she didn’t have any  financial cover. How will she survive? Does a poor child not have the right to life? Why do poor people  suffer a lot while purchasing 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  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 ‘As’. Those are  affordability, availability and accessibility. Health coverage should be affordable and cost friendly, 

health services should be available at decentralised level and easy to access all and health services  available to all with inclusiveness. That brings universal health coverage. Providing UHC has emerged as a  critical requirement for societies, states and all over the country. 

In this essay, we will delve into the significance of universal health coverage, its benefits, challenges of  acquiring universal health coverage and possible strategies for achieving this ambitious goal and role of  government to achieve this. 

Universal Health Coverage: A Platform for healthy India 

First and most significant is that it improves health outcomes. By providing access to timely and affordable  healthcare services, nations can significantly reduce mortality rates, enhance life expectancy, and ensure better  quality of life for their citizens. As per the data published by NITI aayog, timely available hospitalised delivery  reduces CMR (Child mortality Rate) by 75%. That is a huge number. Also it is similar for some chronic diseases, where in rural areas the rate of TB death significantly reduced in Gujarat after having an effective  health care system. 

Next important thing is that the UHC reduces the financial burden on families. As per Bill Gates  foundation report, one single hospital admit in the rural areas pushes the family into poverty trap. That has  been seen during the COVID-19. That extra burden has cascading effects on other life functions. For example,  in Jharkhand, extra burden of health expenditure forced a tribal man to sell his daughter for  prostitution. Such an awakening and disastrous situation! As per study conducted by Pune urban police  department after COVID 19, there has been a fifty percent drop in slum area school enrollment. That shows  these children working as a child labour. 

Increased health costs created problems with hunger and nutritional security. Poor people are not able to  purchase quality nutrients and fall into hidden hunger traps. As per ICMR, 27% children in India are facing  issues of hunger. And that’s why there is the essentiality of Universal health coverage. This frees up resources  that can be utilised for other essential needs, leading to poverty reduction and socio-economic development. 

Next dimension and it is 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. As per World Bank, Increased health cost has different effects on purchasing parity of different  income groups. For example 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. 

Now we will discuss disease level benefits and advantages of universal health coverage. First and foremost is that it will improve Disease Prevention and Early Diagnosis capacity of the country. UHC  facilitates preventive measures, vaccinations, and regular screenings, which can identify health concerns early  on, leading to effective treatment and cost savings. Take the example of Kerala, where good health conditions  and established health facilities show low disease burden on society. As per national health mission, 92%  Public Health Centre (government owned) working effectively that yielded in to very low Infant mortality(6)  and Maternal mortality rate(19). 

Another important advantage is Financial Protection of poor people. UHC safeguards individuals and  families from catastrophic healthcare expenses, eliminating the risk of being pushed into poverty due to  unforeseen medical costs. As per Dr. Arole NGO, if universal health coverage is provided it will directly  impact on increase in saving in Marathwada region. 

UHC has a Patient-Centred Approach, Universal health coverage prioritises patient-centred care,  emphasising individual needs and preferences, resulting in higher patient satisfaction and better health  outcomes. As per NITI aayog India has very low Doctor to bed ratio, low ambulance ratio. So universal health  coverage will challenge such challenges. It will promote the available accessible and affordable health to all. 

 Next dimension is universal health coverage to increase Productivity of the population as well as the health  system itself. Access to healthcare services through UHC enables individuals to maintain good health,  increasing their productivity and contributing positively to the nation’s economy.

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

Important constraint while considering UHC in India is funding. Implementing UHC requires substantial  financial support. National Health Policy also discussed this challenge. India requires at least 2.5% spending  as per national Health Policy. Governments must allocate sufficient funds to healthcare, which can be  challenging, particularly in low-income countries with limited budgets. 

Second is human resource management and availability of Health Infrastructure. Expanding access to  healthcare demands a robust health infrastructure and an adequate number of trained healthcare professionals.  Decentralised health infrastructure has many challenges. First is poor building and unavailable electricity  creating issues of functionality. Second is doctors are not available and ready to work at rural and suburban  level. And third important is competition from private hospitals.As per PIB there is a huge skew in the  distribution of doctors working in the Urban and Rural areas with the urban to rural doctor density ratio being  3.8:1. With these another issue is Very few areas have good colleges of medicine. That’s why the island of  colleges creates the issue of balanced availability of resources. 

Also take the example of Ambulance availability.According to the National Rural Health Mission (NRHM),  6,226 ambulances are available with the government to cater to the country’s rural areas. This is half the  required number of ambulances (see graph on p28). As per the, WHOstandards, there should be at least one  ambulance per 100,000 population in the plains, and one for every 70,000 population in hilly terrain or tribal  areas where population is scattered. 

After the human resource problem next is the problem of Indian bureaucracy, administration and governance. Corruption in health care costs more than money. The price of corruption in health care is paid in  human lives. Corruption at the functioning level of PHC and infrastructure building creates  issues.Implementing UHC involves dealing with administrative complexities, effective governance, and strong  political will. Very high corruption in the medicine field, data complexity and issue of red tapism creates  concern. Decentralisation, capacity building, and efficient public-private partnerships are vital for successful  implementation. 

With above mentioned problems, another important is Behavioural and Cultural Factors of Indian society.  Changing behaviour patterns and cultural norms in healthcare-seeking practices often prove challenging,  requiring concerted efforts towards education, awareness, and community engagement. India has many  superstitions and beliefs on traditional approaches. As per NITI aayog aspirational district programme, in 

Osmanabad district even having available infrastructure, people don’t go to hospital for deliveries and that  resulted in high CMR and MMR. 

Strategies for Achieving Universal Health Coverage: Healthy india – Happy India ‘Health care should be a human right and not a commodity for sale.’  

Although we have challenges, without challenges we don’t know our potential. Our civilization always grows  by accepting challenges and improving on it And that is the basis of a brave, innovative and successful society. 

First strategy is investment from the Government side. Governments need to increase public spending on  healthcare, allocating a significant portion of the budget for UHC. This may necessitate improvement in  taxation systems, prioritising health care financing, and reducing out-of-pocket expenditures. National health  policy focuses on targeted funding rather than single funding. For example separate allocation for doctors  training, separate fund for village level administration etc. 

India can check for some Innovative Financing Mechanisms. Exploring innovative financing models such as  social health insurance, public-private partnerships, and international aid can provide an additional funding  source for UHC implementation. In Kerala community owned financing is prevalent. Or cess for health is also  a good idea. 

After that we need to work on Strengthening Health Systems. Here we can take the help of some civil society  organisations like Magsaysay Prize winner Dr. Arole and his NGO is doing an excellent work in providing  universal health in some areas like Marathwada region of Maharashtra. Also we are required to Invest in health  infrastructure, expanding health facilities in underserved areas, and improving the availability of essential  medicines and technologies are crucial for UHC. Strengthening Gramin Arogya Kendra is the need of the hour. And the most important work to do is effective and quality health workforce development. Governments must  prioritise training, recruitment, and retention of healthcare professionals to ensure adequate human resources  for delivering quality healthcare services. For this purpose we have already started the Public Health Cadre  Management System. Also AYUSHMAN BHARAT is doing excellent, and needs to work on continuous  success. Under this scheme, 83.74 lakh beneficiary families get benefits of availing cashless medical facilities  of upto Rs. 5 lakh per family per year for treatments in nearly more than 1000 procedures in 30 specialities.  These include treatments like hip replacement surgery, knee replacement surgery, renal transplant, etc. That  shows we are placing one step close to UHC. 

And last part of this whole discussion is community involvement and awareness creation. Promoting  community involvement and educating individuals about the benefits of UHC can help overcome cultural  barriers and increase healthcare. College and school students are the best source to educate society. NGO  Snehalaya is doing exemplary work. Recent drive of anaemia awareness and drive of HIV protection in  urban areas by Snehalaya shows decent success. 

Going ahead. 

Universal health coverage is a fundamental requirement of any society aiming to ensure the well-being of its  citizens. By providing equitable access to healthcare services, UHC can enhance health outcomes, reduce  financial burden, and contribute to societal development. Although challenges exist, through concerted efforts,  commitment, and sound policies, nations can work towards realising the goal of UHC and create a healthier  future for all. 

Health care must be recognized as a right, not a privilege. Every man, woman and child in our country  should be able to access the health care they need regardless of their income. 

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