The newspapers are always full of reports of people who have lost their lives as they didn’t have access to and/or couldn’t afford timely healthcare. That’s why governments across the world have been stressing on the need for universal health coverage (UHC). India, with its vast and diverse population, faces a lot of challenges in providing good healthcare for all and making it easily accessible but has launched several initiatives to achieve this.
According to a report, India aims to achieve UHC by 2030 as part of its Sustainable Development Goals (SDG) agenda. This is a very crucial step in realising its vision of becoming a developed nation by 2047.
What is Universal Health Coverage (UHC)?
According to the WHO, Universal Health Coverage (UHC) means that all people have access to the full range of quality health services they need, when and where they need them, without financial hardship. It covers the full continuum of essential health services, from health promotion to prevention, treatment, rehabilitation and palliative care.
To deliver on this promise, WHO says that countries need to have strong, efficient and equitable health systems that are rooted in the communities they serve. Primary health care (PHC) is the most effective and cost-efficient way to get there.
Every country has a different path to achieving UHC and to decide what to cover based on the needs of their populations and the resources at hand. Investing in PHC ensures that all those needs are identified, prioritized and addressed in an integrated way; that there is a robust and equipped health and care workforce; and that all sectors of society contribute to confronting the environmental and socio-economic factors that affect health and well-being, including preparing for, responding to and recovering from emergencies.
According to Visual Capitalist, in 2024, 73 of the 195 countries worldwide had UHC, resulting in around 69% of the world’s population having some form of universal healthcare. These include the UK (through the NHS), Canada, and many European nations.
“We need to make drugs affordable, and also ensure that many of these medicines are manufactured in India. We also need basic science research and diagnostic set ups,” says Dr A V Srinivasan, Emeritus Professor, Tamil Nadu Dr. M.G.R. Medical University and former head and professor of neurology, Madras Medical College.
Dr Srinivasan says that India also needs a good insurance scheme. “In many Western countries such as the US, the individual pays through the insurance scheme, but, in India, the individual has to pay out of their own pocket, or get private insurance, which is expensive,” he says.
Challenges involved in Universal Health Coverage
First, there is the high cost involved. Providing healthcare for a population of over 1.4 billion people would require a massive financial investment. India already faces budgetary constraints, and allocating enough funds to sustain universal healthcare without compromising other important sectors is a significant challenge.
According to The Times of India, around 65% of India’s population, or more than 90 crore people in India, lack social financial health protection schemes owing to coverage gaps and are pushed to procure private insurance for health coverage, said the National President of Indian Medical Association (IMA) Dr RV Asokan.
A significant portion of India’s population lives in rural areas where healthcare infrastructure is underdeveloped. There is a stark contrast between the healthcare quality available in urban and rural areas, with some rural regions lacking adequate numbers of hospitals, clinics, and trained medical staff.
Many parts of India lack essential healthcare infrastructure, such as hospitals, clinics, and medical equipment. Even in cities, government hospitals often face overcrowding, outdated equipment, and insufficient resources. There is also a shortage of doctors, nurses, and other healthcare workers, especially in rural areas, which makes it difficult to provide adequate care to everyone, and the existing medical staff is often overworked.
While more people are opting for health insurance, many people, in low-income groups in particular, lack financial protection against health emergencies, and so they can’t afford treatment, which is heavy on their wallets.
According to a study by Vidhi Centre for Legal Policy, poorly maintained registers of doctors, an opaque style of functioning of regulatory bodies – the present system ends up posing hassles for doctors and patients alike.
The study found that there was a mismatch between the number of registered medical practitioners as per the Indian Medical Register as of September 14, 2023, and information received through RTI applications until December 2022.
What steps are being undertaken by the Indian government?
According to the Press Information Bureau (PIB), under the National Health Mission (NHM), the Government has taken many steps towards universal health coverage, by supporting the state government in providing accessible and affordable healthcare to people.
It encompasses the National Rural Health Mission (NRHM) and the National Urban Health Mission (NUHM) as its two Sub-Missions. Under the NHM, financial and technical support is provided to states/UTs to provide accessible, affordable and quality healthcare, especially to the poor and vulnerable sections of the population, in both urban and rural areas. The NHM provides support for improvement in health infrastructure, availability of adequate human resources to man health facilities, to improve availability and accessibility to quality health care especially for the underserved and marginalized groups in rural areas.
The government has launched four mission mode projects — PM-Ayushman Bharat Health Infrastructure Mission (PM-ABHIM), Ayushman Bharat Health and Wellness Centres (ABHWCs), Pradhan Mantri Jan ArogyaYojana (PMJAY) and National Digital Health Mission (NDHM).
PM-ABHIM was launched as a mission to develop the capacities of primary, secondary, and tertiary care health systems, to strengthen existing national institutions, and create new institutions, to cater to detection and cure of new and emerging diseases.
Under Ayushman Bharat, health and wellness Centres (HWCs), comprehensive primary healthcare by strengthening Sub Health Centres (SHCs) and Primary Health Centres (PHCs) are to be facilitated. A Ayushman Bharat Digital Mission (ABDM) was announced on September 27, 2021, to develop the backbone necessary to support the integrated digital health infrastructure of the country.
Possible solutions
Dr Madhu Shankar, senior consultant cardio thoracic surgeon, Venkateswara Hospital, says that all PHCs need to be upgraded. “More specialists also need to be posted in PHCs, and medical camps need to be conducted annually in every school, urban or rural, so that diseases are detected early,” he says. “Now, we detect a hole in the heart when the person is aged 25 or 30 but it can easily be diagnosed at the age of five or ten. If an ultrasound of the abdomen and echocardiogram are done, then 80% of diseases can be detected and treated.”
Mandatory master health check-ups can also be picked up at an early stage, when many diseases can be treated and reversed, says Dr Shankar. “To ensure everyone can afford it, the government should make it mandatory for even small companies to have ESI (employee state insurance), so that it reaches everybody,” he says.
How NGOs are helping
Smile Foundation has been working to supplement the efforts of the government. The Foundation’s healthcare intervention provides primary healthcare facilities at the doorsteps of the underserved communities in the identified rural areas and urban slums. The aim is to reach the vulnerable population who cannot afford basic healthcare facilities.
Smile Foundation joined hands with GlaxoSmithKline Asia Private Limited (now Haleon) to make dental treatment affordable and accessible and to address the gaps existing in dental healthcare at the community level.
The dental health units have been providing diagnostic as well as curative services through roster based OPDs. Another very important component of the Smile on Wheels Dental HealthCare is the School Oral Health Programme that includes awareness sessions on oral health and hygiene followed by regular dental check-ups.
Two new technology platforms have been integrated in the healthcare programme. ReMeDi is an integrated telemedicine solution that enables teleconsultation where doctors are remotely connected to see the patient, talk to the patient, and can access past medical records. The device enables doctors to conduct over 30 point-of-care diagnostic tests in real-time. Results from these tests are transmitted automatically to the EMR. Doctors can prescribe medicines and also refer for follow-up visits and continuous care.
Health Cube, a state-of-art portable diagnostic system, provides results in 3 to 30 minutes for over 30 tests across various parameters. The system allows smart diagnostics and artificial intelligence to facilitate rapid screening of patients.
