Universal Health Coverage in India: Need & Challenges

• Context (IE): Strengthening affordable, decentralised diagnostics is vital to achieving India’s universal health coverage and reducing healthcare access inequities.

What is Universal Health Coverage (UHC)?

• Universal Health Coverage is a health system goal in which all individuals and communities receive the quality health services they need without suffering financial hardship.
• Achieving UHC is a global target under the 2030 Sustainable Development Goals (SDG target 3.8).

Key components of UHC

• Access to Care: Essential health services should be accessible when needed.
• Quality Services: Services should be effective, safe, and of high quality.
• Financial Protection: Individuals should not face financial distress due to medical expenses.

Constitutional Provisions for UHC

• Article 39 (e): Secures workers’ health.
• Article 42: Emphasizes humane working conditions and maternity relief.
• Article 47: Focuses on improving public health, nutrition, and living standards.

Need for UHC in India

• Out-of-Pocket Expenses: Over 40% of healthcare expenses in India are out-of-pocket, pushing over 60 million Indians into poverty annually.
• Address inequalities in access: Urban institutional deliveries at 94% vs. rural at 88%; specialist availability is 3–4× higher in urban areas (NFHS-5).
• Rapid Rise in Costs: Medical expenses, especially hospital costs, are increasing by ~14% annually, and 23% of hospital bills are financed through borrowing, alarming financially vulnerable households.
• SDG Fulfilment: SDG 3.8 calls for achieving UHC by 2030, including financial risk protection and access to essential services.
  • India’s G20 Presidency placed health security at the core of global development, making UHC a diplomatic as well as domestic priority.

Challenges in Achieving UHC in India

• Low public health expenditure: India’s public health expenditure is only 2.1% of GDP (FY 2023) — far below the National Health Policy, 2017 target of 2.5% by 2025 and the WHO-recommended 5% of GDP.
• Infrastructure deficits: Overall shortages in hospital beds, health professionals, and facilities—rural areas are particularly underserved.
  • Rural India faces shortfalls of over 23% in Sub-Centres, 28% in Primary Health Centres, and 37% in Community Health Centres (Rural Health Statistics 2023).
• Meagre Insurance Penetration: Insurance penetration is only 41% nationally (NFHS-5, 2019-21), with wide gaps — nearly universal coverage in Andhra Pradesh vs. <20% in states like Bihar and UP for PM-JAY beneficiaries.
• Healthcare Workforce Shortage: The doctor-to-patient ratio in the country remains at 1:1,500—well below the WHO-recommended standard of 1:1,000.
• Fragmented Healthcare System: The mix of public and private healthcare providers leads to inconsistency in access and quality.

Government Initiatives for UHC

• National Health Policy (1983): Recognised the goal of “Health for All,” emphasising primary healthcare and equitable resource distribution.
• National Health Policy (2017): Targets UHC with a focus on primary healthcare, prevention, and infrastructure development.
• Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (PM-JAY): India’s world’s largest government-funded health insurance scheme, covering 500 million vulnerable individuals, includes Health and Wellness Centers (HWCs) and PM-JAY.
• National Rural Health Mission (NRHM): Focuses on rural healthcare, maternal and child health, immunisation, and nutrition.

Way Forward

• Public Health System: Strengthen preventive, promotive, and curative health services through robust public health infrastructure.
• Private Sector Integration: Collaborate with the private sector to improve healthcare access, quality, and affordability.
• Technology Adoption: Leverage tools like mobile apps and electronic medical records for enhanced healthcare delivery, particularly in rural areas.
• Community Health Workers: Train and deploy community health workers to bridge healthcare gaps in remote regions.
• Healthcare Workforce: Expand the number and equitable distribution of healthcare professionals across rural and urban areas.
• World-Class Facilities: Develop state-of-the-art hospitals like AIIMS nationwide for equitable access to advanced medical care.
• Policy and Governance: Ensure cohesive policy frameworks, increased political commitment, and decentralized governance for efficient and accountable healthcare management.