Current Status of Universal Health Coverage in India

India has adopted several policies toward improving access to healthcare and has been an enthusiastic signatory to several global health policies to achieve Universal Health Coverage (UHC). However, despite these policy commitments, there has been limited success in realizing these goals. The COVID-19 pandemic has highlighted the urgent need for health system re-design and amplified the calls for such reforms. -

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Universal Healthcare Coverage (UHC) means the quality of health service for all to maintain the health and well-being of the population. UHC is fundamental to achieving SDGs. However, there has been no significant progress toward UHC since 2015, the data indicates globally approximately 4.5 billion individuals were not covered under healthcare services. (WHO, 2023).

Certain barriers to delivery and access to quality healthcare services have been identified such as building robust healthcare systems, weak public healthcare systems, governance, etc. (Kodali, 2023)

It is in this context, that ICT has been identified as having potential and benefits for achieving UHC as it aids in improving access to services specifically in limited-resource settings, improving knowledge, and information for the healthcare workforce and access to better services.  A recent review on UHC in India has indicated that Health Technology Assessment (HTA) is perceived as an important tool for advancing UHC as it can aid in maximizing usage of limited resources and produce evidence-based scientific assessments as it can accelerate progress towards UHC. (Lahariya, 2023)

Thus, the integration of technology in healthcare is essential to improve coverage and provide quality healthcare services. 

References 

Kodali, P. B. (2023). Achieving Universal Health Coverage in Low- and Middle-Income Countries: Challenges for Policy Post-Pandemic and Beyond. Risk Management and Healthcare Policy, 16, 607–621. //doi.org/10.2147/RMHP.S366759

World Health Organization. (2023, October 5). Universal health coverage (UHC). World Health Organization. //www.who.int/news-room/fact-sheets/detail/universal-health-coverage-(uhc)

Lahariya, C., Sahoo, K. C., Sundararaman, T., Prinja, S., Rajsekhar, K., & Pati, S. (2023). Universal health coverage in India and health technology assessment: current status and the way forward. Frontiers in Public Health, 11. //doi.org/10.3389/fpubh.2023.1187567

The Government of India launched the Ayushman Bharat Programme in 2018, a potentially important step in this direction with two major components. First, primary healthcare improvements through investment in 150 000 Health and Wellness Centres (HWCs) and a new cadre of mid-level health providers, accredited for primary care and public health competencies. Over 38 000 HWCs were functional as of April 2020.3 4 Second, an insurance mechanism, the Pradhan Mantri Jan Arogya Yojana (PM-JAY), which aims to cover hospital-level care in both public and private hospitals for over 100 million poor families. 

In keeping with globally recommended best practices on health systems strengthening for UHC, India’s ongoing reform effort makes complementary investments in strengthening primary healthcare and in reducing barriers to hospitalisation. However, managing patients between these levels remains a challenge. Roles and responsibilities need to be clearly allocated between the different levels of the health system. Two-way referral mechanisms between well-equipped health facilities will need to be supported by a system of incentives for patients and providers to seek and provide care at the most appropriate level.4 This calls for greater investments at the primary care level and strengthening HWCs’ role in gatekeeping care.

Source: //gh.bmj.com/content/5/9/e003801

In India, Universal Health Coverage (UHC) is a critical path in achieving equity in health and identifying the unmet needs for quality, and care affordability, a need left behind in the pandemic and that will worsen the situation as climate change grows and impacts health(Chaudhuri et al., 2022).  

According to the National Sample Survey’s 75th round (2017-18), 12% of  Indians did not meet health needs, Financial inaccessibility leads to healthcare unaffordability, which is a major factor responsibile for not meeting the needs. Therefore, a interruption to UHC in India (Dubey et al., 2023). 

The health policy documents in India, such as the National Rural Health Mission (NRHM, 2005), the National Health Mission (NHM, 2013), the National Health Policy (NHP, 2017), and the Ayushman Bharat Health and Wellness Centres (HWCs, 2020) are integrative of the AYUSH systems and reflect the assumption that a single biomedical system cannot achieve UHC. 

1. To achieve Universal Health Coverage (UHC), we need innovative healthcare models that combine traditional and modern medicine. Traditional practices excel in primary care, disease prevention, and mental well-being, while modern medicine is crucial for critical care. Research should focus on wellness, immunity, and collaboration between different medical systems. Understanding societal dynamics and promoting cross-system communication is vital for inclusive healthcare.
2. Including traditional AYUSH practices in all health system levels is essential. While AYUSH personnel filled gaps in staff shortage, efficient AYUSH services require strategic integration with modern medicine, prioritizing community-based practices.
3. To improve healthcare, we should use real-world data and AI to study both traditional and modern medicine's effectiveness. Analyzing data from 100 reputable clinics can provide better insights than traditional trials. However, we must be cautious about over-medicalization and respect the holistic nature of traditional systems, acknowledging their unique philosophy that embraces modern medicine(Chaturvedi et al., 2023).

References: 

1. Chaudhuri, A., Biswas, N., Kumar, S., Jyothi, A., Gopinath, R., Mor, N., John, P., Narayan, T., Chatterjee, M., & Patel, V. (2022). A theory of change roadmap for universal health coverage in India. Frontiers in Public Health, 10. //doi.org/10.3389/fpubh.2022.1040913
2. Dubey, S., Deshpande, S., Krishna, L., & Zadey, S. (2023). Evolution of Government-funded health insurance for universal health coverage in India. The Lancet Regional Health - Southeast Asia, 13(100180), 100180. //doi.org/10.1016/j.lansea.2023.100180
3. Chaturvedi, S., Porter, J., Gopalakrishna Pillai, G. K., Abraham, L., Shankar, D., & Patwardhan, B. (2023). India and its pluralistic health system – a new philosophy for Universal Health Coverage. The Lancet Regional Health - Southeast Asia, 10, 100136. //doi.org/10.1016/j.lansea.2022.100136

Enhancing the comprehensiveness of primary health care is crucial, and the Health and Wellness Centers initiative by the Government of India is a positive move towards broadening its scope beyond just maternal and child health. This shift is essential in addressing the evolving epidemiological landscape and the rising prevalence of non-communicable diseases. Recognizing that the health system is intricately linked to the social system, it is imperative to consider social determinants of health. A holistic evaluation of the health system's performance is necessary for both preventive and curative care services.

While strengthening the public sector is vital, capacity constraints may require strategic engagement with the private sector, particularly for tertiary and, in some cases, secondary care. However, the private sector comprises diverse institutions with varying levels of sophistication in services and qualified personnel.

Reference: 

Sharma, A., & Prinja, S. (2018). Universal health coverage: Current status and future roadmap for India. International Journal of Noncommunicable Diseases, 3(3), 78-84.