Universal Healthcare Scheme in India and Politics
UNIVERSAL HEALTHCARE SCHEME IN INDIA AND POLITICS
- Harshini Iyengar, Symbiosis Law Schoo, Pune
INTRODUCTION
Universal Health Coverage(UHC) says that all people must get, without monetary and financial problems, receive adequate healthcare services, which is agreed upon by all the member states by the United Nations, and providing UHC is a part of Sustainable Development Goals (SDGs) [1].
India, being a member country of the UN, has its role in UHC as well . In India, the main goal of UHC is to ensure that all the citizens of the country have equal access to affordable, responsible healthcare facilities of sufficient and adequate quality, irrespective of their any social or economical boundaries, like caste, religion, social status etc.[2]
PRINCIPLES
1. Universality
2.Equity
3. Non-exclusion and non-discrimination
4. Comprehensive care that is rational and of good quality
5. Financial protection
6. Protection of patients’ rights that guarantee appropriateness of care, patient choice, portability and continuity of care.
7. Consolidated and strengthened public health provisioning
8. Accountability and transparency
9. Community participation
10. Putting health in people’s hands.[2]
WHY IS UHC NEEDED
1. In India, close to 600 million of the population does not get healthcare facilities, about 63 million are in poverty due to costs of healthcare[1]
2. India has the second lowest expectation rate in South Asia.
3. India has lesser than 1% of GDP allocated for healthcare services, so it becomes a big burden on the citizens.
4. Even the healthcare facilities that are available are not adequate enough or accessible to all.
SOME SCHEMES UNDER UHC
1. NATIONAL RURAL HEALTH MISSION
- Launched in 2005
- Aims at providing accessible, affordable and quality health care to the rural population,
- It has sought to reduce
Maternal Mortality Ratio - 407 to 100 per 100,000 live births,
Infant Mortality Ratio - 60 to 30 per 1000 live births
Total Fertility Rate - 3.0 to 2.1 within the seven year period of the mission
2. AYUSHMAN BHARAT
i.The Ayushman Bharat is one of the most ambitious health missions ever to achieve UHC . [2]
ii. Ayushman Bharat encompasses two schemes, Health and Wellness Centres and National Health Protection Scheme.
iii. Health and Wellness Centres are seen as a root of the health system to give comprehensive primary care, free essential drugs and diagnostic services
iv. National Health Protection Scheme is made to give financial risk protection to poor families raising secondary and tertiary care hospitalization upto of five lakh rupees per family per year.[3]
v. At the national level to operate, an Ayushman Bharat National Health Protection Mission Agency (AB-NHPMA) would be made . States would be advised to implement the scheme by a focused and dedicated entity called State Health Agency . They can use an existing Trust/ Society/ Not for Profit Company/ State Nodal Agency or make a new entity to implement the scheme.[4]
vi. States/ UTs can decide to implement the scheme through an insurance company or directly from the Trust or use integrated model.
vii. Ayushman Bharat - National Health Protection Mission gives benefit to about 10.74 crore poor, deprived rural families and identified occupational category of urban workers\' families as per the latest Socio-Economic Caste Census data covering both rural and urban. The scheme is made to be dynamic and aspirational and it would take into account any future changes in the SECC data.[4]
Impact Of Ayushman Bharat
1. Helps nearly 40% of the country, which is a huge help for the welfare of the country
2. Almost all secondary and many tertiary hospitalizations are covered
3. 5 lakh for each family is provided,[4]
This will pave the way to increase access to sufficient quality health and medication. Also, the unattended necessities of the population which were not known due to lack of financial resources will be facilitated. This will lead to treatments in time, improving health outcomes, patient satisfaction, increases in productivity and efficiency, job creation thus leading to improvement in quality of life.
UHC AND POLITICS
It is a political achievement that UHC is debated at all, and even more so that it has some sort of consensus. UHC is a rather political term. Within the field of global health governance, it is part of an ongoing discussion on the relative importance of "vertical" goals, such as disease eradication and a wider "horizontal" system — strengthening proposals.[2] Despite the momentum behind disease-specific initiatives and the appeal to tackle particular problems (e.g. antiretrovirals or polio eradication), it is often difficult to argue .
UHC is costly and redistributive; this is enough to make it contentious. As if this were not enough, UHC also pursues other contentious goals, such as productivity or access to medicines. It is unwise to conclude that the goals of the UHC are rooted in the countries that have essentially accomplished them, to overstate the Influence of health ministries or advocates dedicated to UHC, or overstate the degree of agreement among governments that have adopted them on paper.[5]
Democracy and partisanship will not necessarily produce UHC; UHC also needs organized support and faces organized resistance. Unorganized citizens are unlikely to see their interests represented in any political structure. The dynamics of organisation, political coalitions, and parties, a long-standing problem in comparative politics, therefore call for attention; the relationship between left-party progress and UHC policies is not clear, and part of the explanation is the connection between politics and governance.
In India , it is often said that UHC requires political will to be implemented. It is also seen that there is very little allocation of GDP in the healthcare schemes.
While schemes like Ayushman Bharat have shown great progress and we see newer and newer schemes being introduced, we also have seen the half hearted attempts in politics.
1. Sanitation at public hospitals is really a big problem, and it shows a lack of political involvement.
2. India is not having the funds to allocate to the cause.
3. Health is often treated as a secondary subject in India.
4. In most countries, an outcome of political discourse and combined result of ongoing political negotiations evolved from the political situations prevailing during and after the period of industrial revolution is UHC. Strangely,any such demand is near absent in the current Indian political scenario.[2]
India has expressed its political commitment to achieve universal health coverage by 2020, but India is a far cry from achieving the same. The absence of political head on the social sector including health, and an unregulated, rapidly blossoming private sector is the major reason to the above
THE NEGATIVE ASPECT
India faces a lot of hindrance to achieve UHC by 2022 such as high disease prevalence, gender equality issues , poorly regulated and broken health-care delivery system, unavailability of sufficient and adequate skilled human resource, vast social determinants of health, inadequate finances, lack of inter-sectoral co-ordination and various political of different forces, and interests.
WHAT CAN BE DONE TO IMPROVE
For India to take a winning leap and overcome these challenges, innovative partnerships and new investments are required across the health value chain. Here\'s how India can turn the challenges of providing UHC into opportunities
1. Sustainable financing and investment instruments to strengthen infrastructure
2. Building the capacity of the healthcare workforce
3. Fostering new technologies for last-mile delivery and continuum of care
4. Integrating healthcare for scale and global impact
5. It is therefore important to define and agree the vision and goals for 2030.
6. Possibilities for accelerating the UHC in states: states have the opportunity to speed up the transition process to UHC.
7. High-level political engagement for investments in the health sector is essential to driving the UHC agenda both in the center and in the states.. A similar commitment is also required in the states.[6]
8. Political engagement is essential, community participation is also essential for progress towards UHC. Government and NGO institutions, including think tanks and private sector actors, play an important role in defending UHC and lobbying for its effective implementation. Building a UHC vision for the country based on strong commitment and holistic participation will be a solid foundation for the country\'s future.[6]
9. More money for health, but also more health for money: The health sector has enormous potential to directly contribute to improving the quality of human capital, which will make other sectors more productive. [6]
10. Public health facilities need to be strengthened and working conditions for public health workers improved, particularly in rural areas. This includes important medicines and supplies, training and ensuring an appropriate mix of qualifications, as well as a functioning referral system for complicated cases.
REFERENCES
[1]The Elders : Universal Health Coverage (UHC) in India (2018) <https://www.theelders.org/sites/default/files/the_elders_-_uhc_india_health_report_final-forweb_0.pdf> accessed on 14April, 2020
[2]United Healthcare\', (United healthcare, 27 May 2016)<https://www.uhcindia.com/web/> accessed on 15April, 2020
[3] Press Information Bureau, Government of India. Ayushman Bharat for a New India-2022. 2018. Available from: http://www.pib.nic.in/newsite/PrintRelease.aspx?relid=176049 .[accessed on March 27, 2018].
[4] Ayushman Bharat, National Hralth Protection Scheme\'(Ayushman Bharat, 22 October 2018)<https://www.india.gov.in/spotlight/ayushman-bharat-national-health-protection-mission>accessed on 14April, 2020
[5] World Health Organization. Health Systems Financing: The Path to Universal Health Coverage. Geneva, Switzerland: World Health Organization; 2010.<https://www.who.int/whr/2010/en/>accessed on 13April, 2020
[6] Dr Henk Bekedam‘Health for All: Accelerating Universal Health Coverage in India’ Business Times,(Delhi, 27 January 2016)
