Making universal health coverage a realityDr Usha Manjunath
India’s health system development has come a long way since the Alma Ata declaration in 1978, which was the first international conference on primary health care. Now, the government is making a progressive move to eliminate more complex menaces like non-communicable diseases. The union healthcare budget 2018 is definitely a gigantic move by the center towards universal health coverage (UHC). However, when it comes to accomplishing UHC in India, the country is posed with numerous problems.
Healthcare delivery system:
According to Rural Health Statistics 2015, at least 6 large states had almost 40% shortfall of community health centers and Bihar has the highest shortfall at 91%. Furthermore, many of these states do not even have enough number of public health centers. Currently, India has 1 government hospital bed for every 2,046 people and one state-run hospital for every 90,343 people. In fact, with the divide between urban and rural in the healthcare system of India, the quality of healthcare services is not ubiquitous. Excessive commercialization of private sector and lack of efficiency in public healthcare facilities have just been aggravating the problem in the healthcare system.
Contorted distribution of skilled human resources:
According to National Health Profile 2017, only 10% of healthcare professionals work in the public sector. This wider gap and uneven distribution of medical fraternity among the public and private sector has been making the implementation of plans by the Centre more complex. The problem of lack of medical practitioners has been acuter in rural areas and the larger rural population is not even aware of the available facilities as well. This has been a major concern that has been an impediment on the way to achieving UHC.
According to Institute of Health Metrics & Evaluation, University of Washington, India stands 6th among 25 countries which spend more than 50% on out of pocket expenditure. In fact, according to reports of Health Ministry of India, over 63 million people face poverty every year due to healthcare costs alone. Also according to Aarogya Bharat 2015, 70% of people do not even have health insurance. All these factors are definitely adversely contributing to healthcare finance of the country, which is not in such a good shape.
Stunted technological embracement:
With increasing, use of high-end technology in everyday practice is further pushing the healthcare costs up. At best, patchy implementation of schemes like Jan Aushadhi and variability has not been able to reduce the burden of spiraling cost of medicines. The need for the country’s healthcare system to fight much complex health anomalies is highly needed. According to WHO reports of 2016, 61% of deaths in India attributed to non-communicable diseases. Thus, the country should focus on taking the burden of out of pocket expenditure on the citizens and adopt more sophisticated technologies to fight non-communicable diseases.
Health Information System:
The information system in India is not running smoothly. The data accuracy, quality and integration, and completeness of various health data haven’t reached the maturity level. The Swastha Bharat mobile application for information on diseases, symptoms, treatment, health alerts and tips; ANMOL-ANM online tablet application for health workers, e-RaktKosh (a blood-bank management information system) and India Fights Dengue are in pipeline. However, we have a long way to go in using HIS for evidence-based public health programmes, measuring of outputs/outcomes, EMR and Clinical Information Systems.
Leadership & Governance:
In the end, leadership, and governance, the foundation of any well functioning system at best is a talking point. There is probably more politics, both in private and public sector than governance. A number of factors like transparency, due diligence and good governance in financial, HR, System performance and practices need a thorough overhaul of the system.
The road ahead:
The road may be rough and long for health system reforms but the Odyssey has begun, we have no choice but to buckle up and strive hard. With the major change in the year’s health budget and the biggest government-funded healthcare programme, we are definitely looking for the best.
Even though initiatives like Ayushman Bharath, Swasthya Bima Yojana (RSBY) and Senior Citizen Health Insurance Scheme (SCHIS) etc sound promising; needs very good implementation and monitoring mechanisms to realize UHC in the long run. When paid heed to the above factors and worked towards to eliminating them, universal health coverage can actually be a reality for India.