By Mary Magdalene Rynjah
Universal Health Coverage (UHC) is about ensuring that people belonging to all communities have access to quality health services whenever and wherever needed and without having to face any financial hardship. These services include health promotion in prevention, treatment, rehabilitation as well as palliative care and all this is to be achieved through the primary healthcare system. The three main objectives of UHC are equity in accessing health services, delivering the health services of effective quality and people protection against financial-risk (WHO).
Still a Long Way for India?
Union Finance Minister Arun Jaitley said, “Only Swasth Bharat can be a Samriddha Bharat”, meaning ‘Healthy India is Prosperous India’ and ‘India cannot realise its demographic dividend without its citizens being healthy’. Without a doubt, the Indian government has brought about several initiatives to enable achieving UHC. Such initiatives include:
The National Health Protection Scheme- the Pradhan Mantri Jan Arogya Yojana (PMJAY), a promising programme that will cover over 10 crore poor and vulnerable families (approximately 50 crore beneficiaries) providing coverage up to Rs 5 lakh per family per year for secondary and tertiary hospitalisation.
1.5 lakh health and wellness centres, which will bring health services closer to people’s homes providing comprehensive care in addition with non-communicable diseases, maternal and child services.
Free essential drugs and diagnostic services and allocation of 1,200 crores for the programme.
Nutritional support of Rs 500 to each TB patient for the duration of their treatment.
All these are very ambitious initiatives in the approach to achieve India’s target for UHC by 2022 but with policy; infrastructure and implementation as well as sustenance must go hand in hand. All these policies are meant to bring healthcare nearer to people’s homes, reaching the unreached as well as in reducing the out of pocket expenditure (OOPE) which India stands at 62 per cent currently as only 15 per cent of the population are covered by health insurance (bulletin of WHO). India stands as the sixth biggest out-of-pocket (OOP) health spender among the low-middle income group of 50 nations as reported by IndiaSpend on 2017.
The Planning Commission of India constituted the high-level expert group (HLEG) on UHC in 2010 and submitted its report in 2011, achieving UHC for India by 2022. India is marching towards UHC like many other countries. However, are we on the right track? The WHO Constitution states, ‘the enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition’. Will this right be fulfilled for 1.3 billion citizen of this country? The second largest most populated country in the world. That is the bigger question!
Challenges
The cost: According to recent article published in Business Standards on June 2018, Rs 3 per day and Rs 1,112 per person in a year is the amount spent by the Indian Government on health for its citizens. In a study conducted by the WHO (2018), the cost estimate of delivering UHC in India through the combined efforts of public and private sectors would be Rs 1,713 per person per year.
On extrapolation of these costs, the Indian government needs to spend 3.8 per cent (2.1–6.8 per cent) of the GDP for universalising healthcare services. However, currently the GDP spent on health in our country is a little over 1 per cent which is more than three times lesser to the model estimate. Our neighboring country like Sri Lanka is spending four times more on GDP for health than our country (Business Standards).
NITI Ayog has projected a premium of Rs 1,000 to Rs 1,200 per family per annum for the five lakh health insurance coverage. With the recent National Health protection Scheme covering 10 crore families, the total estimated expenditure from the central and state government comes to 12,000 crore per annum with a ratio of 60:40, respectively. The Union budget has allocated Rs 2,000 crore in 2018-19 health budget for the partial implementation of the programme.
Manpower in rural areas: The problem of deploying the healthcare professionals especially doctors has been a challenge in the Indian healthcare system. According to the National Health Profile (2018), there is only one doctor for 11,082 people across the country with a shortage of 10 doctors for another ten thousand people. As per the prescribed recommendations of the WHO the doctor population ratio is 1:1000. India is also at a shortage of 1.94 million nurses, as reported by NDTV- IndiaSpend analysis (2017) of data from the Indian Nursing Council (INC) and World Health Organization (WHO). With such a deficiency in the health workforce, deploying and sustaining them at the periphery would be a mountain that the Indian healthcare system is anticipating to conquer.
The Scenario in NE
Meghalaya with a population of more than 29 lakhs people (Census 2011) is significantly at a better position in per capita healthcare expenditure with Rs 2,366 and is among the top ten states with highest health spending (Observer Research Foundation). Meghalaya Government in an endeavor to achieve universal health coverage, started the Megha Health Insurance Scheme (MHIS) in 2012 in the state that does not confine to only BPL families but has been extended to everyone. Data from MHIS source reports that in the third phase of MHIS, out of the total 8,86,034 households; 4,36,788 were enrolled under the scheme resulting in a total coverage of nearly 50% households in the state. With the fourth phase being implemented working in convergence with Ayushman Bharat, the insurance cover has increased from Rs 2,80,000 (five members) to Rs 5 lakh for all families of the state, excluding State and Central government employees. As per the Department of Health and Family Welfare (Government of Meghalaya) website, the total number of doctors, nurses and ANMs working under the government are 684, 893 and 758 (2008-09) respectively.
Mizoram’s per capita health expenditure is Rs 5,862, which is almost five times than the Indian average (4.4 per cent of GDP on health), followed by Arunachal Pradesh (Rs 5,177) and Sikkim (5,126) at the top while Nagaland spends Rs 2,450 on health per person per year (Observer Research Foundation). The health expenditure alone cannot boost the health outcomes in the state but is a critical component in laying the foundation towards the right direction.
It is essential that the healthcare policies planned and implemented in the country follows in the direction of achieving the Sustainable Development Goals (SDGs) in ensuring good health and well-being for all and at all ages. UHC is expected to overcome the inequalities faced by the people related to healthcare access, especially addressing the concern of the poor and vulnerable- ‘to reach the unreached’.
(The author is an intern at the Indian Institute of Public Health, Shillong)