UNIVERSAL
HEALTH COVERAGE/CARE – HEALTH
News: Moving forward with a newer concept of
Universal Health Care
What's
in the news?
●
The article underscores the need to move
forward with a newer concept of UHC, with an intersectoral convergence beyond
medical and health departments.
●
It also put emphasis on moving forward
from the Alma Ata declaration of primary health care towards a holistic model
governing all levels of healthcare.
Definition
of Health by WHO:
●
A certain totality of health to the realms
of mental and social well-being and
happiness beyond physical fitness, and an absence of disease and
disability.
Universal
Health Coverage:
●
UHC means that everyone, everywhere, should have access to the health services
they need without risk of financial hardship.
●
It means that all people have access to
full range of quality health services and nobody is denied this and everybody
is eligible without being discriminated against on the basis of financial
status, gender, race, place of residence, affordability to pay or any other
factors.
●
It covers the full continuum of essential
health services, from health promotion to prevention, treatment, rehabilitation
and palliative care.
●
It thus encompasses primary, secondary and
tertiary care for all who need it at affordable cost without discrimination.
Indicators
of Universal Health Coverage as per WHO:
Concept
of 'Health for All':
●
The slogan “Health for All by 2000” that
was proposed by Halfdan Mahler and endorsed by the World Health Assembly in 1977.
●
Universal Health Care/coverage (UHC) was
implied as early as 1977. India, through its National Health Policy 1983, committed itself to the ‘Health for
All’ goal by 2000.
Focus
on Primary Health Care:
●
The International
Conference on Primary Health Care, at Alma Ata, 1978, listed eight components
of minimum care for all citizens such as
○
Education concerning prevailing health
problems and the methods for preventing & controlling them.
○
Promotion of food supply and proper
nutrition.
○
Adequate supply of safe water and basic
sanitation.
○
Maternal and child health care, including
family planning.
○
Immunisation against major infectious
diseases.
○
Prevention and control of locally endemic
diseases.
○
Appropriate treatment of common diseases
and injuries.
○
Provision of essential drugs.
●
It mandated all health promotion
activities, and the prevention of diseases including vaccinations and treatment
of minor illnesses and accidents to be free for all using government resources,
especially for the poor.
Difference
between PHC and UHC:
●
The main difference between PHC and UHC is
that PHC is a level of care within the healthcare system, while UHC is a broader goal of ensuring access to
health care for all individuals.
●
PHC is typically provided at the primary
care level, while UHC includes all levels of care, from primary to secondary
and tertiary care.
●
PHC is focused on basic health care
services and health promotion, while UHC aims to provide comprehensive health care services to all individuals.
Issues
in Primary Health Care:
●
Any non-communicable disease, chronic
disease including mental illnesses, and its investigations and treatment were
almost excluded from primary health care.
Issues
in Secondary and Tertiary Care:
●
State was almost failed in their duty and
it was mostly left to the individual
care.
●
Limited
number of public hospitals and enough government-run
institutions for the poor (who cannot afford exploitative and expensive private
care).
●
Increasing
out of pocket expenditure from their own pockets in private
sectors.
●
Abdication
of responsibility by the state i.e., to provide secondary
or tertiary care by the state, ensured the dominant, unregulated, profit-making
private sector and also health insurance sector were kept happy and thriving.
●
Dichotomy
between peripheral primary and institutional-referred specialist care at the
secondary and tertiary levels.
International
Efforts:
1.
WHO’s Thirteenth General Programme of Work aims to have 1
billion more people benefit from UHC by 2025, while also contributing to the
targets of 1 billion more people better protected from health emergencies and 1
billion more people enjoying better health and well-being.
2.
International Universal Health Coverage Day (December 12)
aims to raise awareness of the need for strong and resilient health systems and
universal health coverage with multi-stakeholder partners.
3.
SDG Target 3.8 - Achieve universal health coverage,
including financial risk protection, access to quality essential health-care
services and access to safe, effective, quality and affordable essential
medicines and vaccines for all.
4.
The Astana declaration of 2018 calls for “partnership”
with the private sector and multi-nodal system of varied sectors, professional
streams and specialities with a variety of staff to deliver Comprehensive
Universal Health Care.
Measures
taken by India:
1.
National Rural Health Mission (NRHM) 2013 - Primary Health
Care (PHC) Version 2 or Comprehensive PHC was defined to treat chronic
illnesses and non-communicable diseases such as cardiac, neural, mental and
metabolic disorders.
2.
Pradhan Mantri Jan Arogya Yojana - Operationalisation of
the Health and Wellness Centre as a model of implementation of Comprehensive
Primary Health Care. The mission under Pradhan Mantri Jan Arogya Yojana (PMJAY)
initiative, established 150,000 health and wellness centres (HWCs) and provides
health insurance coverage to 40% of the country’s population - nearly 500
million people.
3.
The National Health Policy (NHP) 2017 commits to free
provision of primary care by the public sector, an assured, comprehensive
primary care with linkages to referral hospitals, assured free drugs,
diagnostic and emergency services to all in public hospitals.
4.
The National Medical Commission (NMC) Act recognizes the
much-needed reforms in medical education with the vision of “one nation, one
healthcare sector”.
5.
Telemedicine in India is growing at a compound annual
growth rate (CAGR) of 20% and is expected to reach a value o $32 million by
2020.
6.
Machine learning, block chain and AI will continue to
strengthen India’s ability to engage effectively with other geographies towards
achieving global UHC targets.
Challenges
ahead:
Despite of reaching
towards UHC, there are significant challenges in the healthcare value chain
such as
1. It includes gaps in healthcare infrastructure, a
divergence between rural and urban geographies, an acute shortage of skilled
workers and inadequate public funding, to name a few.
2. A crucial component of
Ayushman Bharat is the strategic purchasing of secondary and tertiary
healthcare services from the private
sector.
3. While private
healthcare caters to around 70% of India’s population, there is an estimated shortage of 160,000 additional hospital
beds under the scheme.
4. India requires twice the number of doctors,
triple the number of nurses and quadruple the number of paramedic and support
staff.
WAY
FORWARD:
1. The starting point for
universal health coverage is the political
will and commitment to make substantial public investments in healthcare
consistently.
2. Coverage of the
population with an adequate number of health facilities with an optimal mix of health workers is the
foundation on which the journey towards UHC is premised.
3.
Bold and innovative policies sustained over a long
period are needed to train and retain a skilled health workforce.
4.
Availability of portable benefits, telemedicine and wide network of diagnostic
labs
does hold the promise of extending the reach of primary care to all citizens.
5.
Tax-based financing, supplemented by a single mandatory
social health insurance scheme for those employed in the formal sector, that is
collected in a single pool of revenue offers the most feasible route to UHC in
settings with a large informal sector.
6. The range of services
available at no cost at the point of service needs to be comprehensive,
covering both outpatient and inpatient care and the cost of drugs.
7.
Publicly financed social insurance schemes for low-income
populations do not succeed in expanding population coverage to universality.
8. Need for an intersectoral convergence beyond
medical and health departments such as women and child development, food and
nutrition, agriculture and animal husbandry, civil supplies, rural water supply
and sanitation, social welfare, tribal welfare, education, forestry.
9. The National Health Mission with concurrent
intersectoral thrusts on Poshan Abhiyan, National Food Security, the Mahatma
Gandhi National Rural Employment Guarantee Act, water sanitation, Sarva Shiksha
Abhiyan, etc. is a better model of fully tax-funded Universal Health Care.
Every individual has a
right to be healed and not have complications, disability, and death. That
right is guaranteed only by individualism in public health, the new global
approach to UHC, where nobody is left uncounted and uncared for.