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Universal Health Coverage in India – Status of Ayushman Bharat, Public Health

Universal Health Coverage in India – Status of Ayushman Bharat, Public Health

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  • GS 2 || Governance & Social Justice || Human Development || Health

Why in the news?

A situation in which everyone is eligible for basic healthcare services is referred to as “universal coverage.” This is a scheme in which all Indian people, regardless of their economic, social, or cultural backgrounds, will have the right to accessible, accountable, and adequate health care that is specified in a published package of services and benefits.

Introduction:

  • Universal Health Coverage (UHC) covers three key elements — access, quality, and financial protection.
  • India is committed to achieving Universal Health care for all by 2030, which is fundamental to achieving the other Sustainable Development Goals.
  • Working of Ayushman Bharat:
    • Ayushman Bharat, the government of India’s flagship programme, was launched in September 2018 to realize the vision of Universal Health Coverage, as recommended by the National Health Policy 2017. (UHC).
    • This initiative was created to fulfill the Sustainable Development Goals (SDGs) and the program’s overarching promise to “leave no one behind.”
    • PM-JAY is the world’s largest health insurance/assurance program, with a cover of Rs. 5 lakhs per family per year for secondary and tertiary care hospitalization.
  • UHC is firmly based on the 1948 WHO Constitution, which declares health a fundamental human right and commits to ensuring the highest attainable level of health for all.
  • UHC means that all individuals and communities receive the health services they need without suffering financial hardship.
    • It includes the full spectrum of essential, quality health services, from health promotion to prevention, treatment, rehabilitation, and palliative care.
  • WHO is supporting countries to develop their health systems to move towards and sustain UHC, and to monitor progress.

UHC should focus on two things:

  • Proportion of a population that can access essential quality health services
  • Proportion of the population that spends a large amount of household income on health

India’s efforts towards UHC:

  • In 2018, India took a step closer to achieving the SDGs by launching Ayushman Bharat, a national health care program aimed at achieving universal health coverage
  • The mission, which is part of the Pradhan Mantri Jan Arogya Yojana (PMJAY) initiative, has developed 150,000 health and wellness centers (HWCs) and provides health insurance to nearly 500 million people, or 40% of the country’s population.
  • In its first year of implementation, Ayushman Bharat has reached nearly 4.9 million Indians who have benefited from cashless care, saving $1.6 billion for the families who have benefited.
  • It has superior IT and governance structures in terms of activities, and it is building state capacity in management and governance
  • These measures is a response to India’s high Out-of-Pocket (OOP) spending, which is one of the highest in the world at nearly 60%.
  • The National Health Policy (NHP) 2017 commits to the public sector providing free primary care, ensuring quality primary care with links to referral facilities, and ensuring free medicines, diagnostic, and emergency services to those in public hospitals.
  • With the vision of “one country, one healthcare sector,” the National Medical Commission (NMC) Act recognizes the critical need for reforms in medical education.
  • Telemedicine in India is projected to hit a value of $35 million by 2021, with a compound annual growth rate (CAGR) of 20%.
  • Machine learning, blockchain, and artificial intelligence will continue to improve India’s ability to collaborate efficiently with other countries in order to meet global UHC goals.

Indicators of Universal Health Coverage

WHO uses 16 essential health services in 4 categories as indicators of the level and equity of coverage in countries

  • Reproductive, maternal, newborn and child health:
    • Family planning
    • Antenatal and delivery care
    • Full child immunization
    • Health-seeking behavior for pneumonia.
  • Infectious diseases:
    • Tuberculosis treatment
    • HIV antiretroviral treatment
    • Hepatitis treatment
    • Use of insecticide-treated bed nets for malaria prevention
    • Adequate sanitation.
  • Non-communicable diseases:
    • Prevention and treatment of raised blood pressure
    • Prevention and treatment of raised blood glucose
    • Cervical cancer screening
    • Tobacco (non-)smoking.
  • Service capacity and access:
    • Basic hospital access
    • Health worker density
    • Access to essential medicines
  • Health security: compliance with the international health regulations.

Challenges:

  • Despite progress toward UHC, the healthcare value chain faces major obstacles.
  • Insufficient public funding: It entails, among other things, disparities in healthcare facilities, a divide between rural and urban geographies, a severe shortage of qualified staff, and insufficient public funding.
  • Strategic procurement of secondary and tertiary healthcare facilities from the private sector is a critical component of Ayushman Bharat. Though private healthcare serves roughly 70% of India’s population, the scheme is expected to be short of 160,000 additional hospital beds.
  • India needs twice as many doctors, three times as many nurses, and four times as many paramedics and support personnel.
  • Worse still, even if the WHO’s goal of one doctor per 1000 people is met in the next six years, there is a significant imbalance among individual states.

Suggestions to archive full UHC in India:

  • The political will and determination to make significant public investments in healthcare on a regular basis is the starting point for universal health coverage.
  • The basis on which the path towards UHC is based is community coverage with a sufficient number of health facilities and an appropriate mix of health staff.
  • To trained & professional health workforce, bold and creative policies must be implemented over time.
  • The availability of wearable benefits, telemedicine, and a large network of testing laboratories all hold the promise of expanding primary care’s scope to all residents.
  • In environments with a broad informal sector, tax-based finance, supplemented by a single mandatory social health insurance system for those working in the formal sector, raised in a single pool of revenue, is the most feasible route to UHC.
  • The variety of free services available at the point of service must be extensive, including outpatient and inpatient treatment.
  • Raise government spending on drug procurement to 0.5 percent of GDP and make vital drugs available to all.
  • Enforce price management and price restraint on all Essential Drug List formulations.
  • Publicly funded social insurance plans for low-income people do not achieve universal coverage.
  • Protect the safeguards provided by the Indian patents law and the TRIPS Agreement against the country’s ability to produce essential drugs.

Way Forward:

  • National Health Mission’s Free Drugs and Diagnostics Services Initiatives needs to be made more effective in line with the promise in the National Health Policy.
  • It requires careful thought and planning. The National Digital Health Mission (NHDM) provides this opportunity by improving data linkages between the National Health Mission (NHM) and PMJAY.

Conclusion:

After years of AB PMJAY should serve as both, a celebration of the long way India has come in its UHC journey, but also a reminder of the long and difficult road that lies ahead. An encouraging aspect of India’s commitment to UHC has been the active and participatory role of the government. From Poshan Abhiyaan, which aims to eliminate the malaise of malnutrition, to the Prime Minister’s call for a Fit India Movement, new emphasis has been given to multi-stakeholder engagements. For a sustainable UHC model, maintaining a balanced trade-off between cost, quality and access to healthcare services is critical.

Mains oriented question:

Since the pandemic, achieving universal health care for everyone is a bumpy road for the state and stakeholders. Analyze the effects of a pandemic on women and children critically.