Grey areas in universal health coverage in India

India is a land of contrasts and its provision of healthcare is no different. While wealthier people living in urban areas have access to high quality healthcare services, a vast majority of people living in rural areas have very limited access to quality healthcare. Every year, countless households are pushed into extreme poverty as a result of expenditure out of an individual's pocket on his health. Though UHC is one of the 17 Sustainable Development Goals (SDGs) adopted by the United Nations for eliminating poverty, the grassroot scenario in India is bleak. Significantly, 70 per cent of healthcare is provided by the private sector in India. There is a large health disparity between social classes, urban and rural populations and geographical locations.

Smart targets for achieving UHC:
Efficiency is key to moving towards Universal Health coverage (UHC), and priority setting is essential to getting the maximum value for the money spent. There are seven smart targets that need to be prioritised to achieve UHC in India. These are:
1. Reducing child undernutrition and chronic diseases
2. Reducing the number of malaria infections
3. Reducing the number of tuberculosis deaths
4. Lowering the newborn mortality rate
5. Increasing the number of childhood immunisations
6. Improving access to family planning
7. Reducing indoor air pollution

Major challenges:
The first challenge (even after 13 years of the launch of the NRHM and subsequent National Health Mission) is the wide disparity in the quality of healthcare services in the public and private sector as regulatory standards are neither established nor enforced properly by the Government of India. Unless strict laws are formulated by the Ministry of Health and Family Welfare (MOHFW) and the Indian Council of Medical Research, the country cannot attain success.

Secondly, the issue of quacks and traditional healers treating patients at the grassroot level is a serious concern. This is connected to the poor availability of healthcare services and service providers in rural areas. The government has not formulated any Bill to curb these malpractices. The extent of harm, morbidity and mortality resulting from such treatments is devastating.

Thirdly, the non-affordability of healthcare services is a major problem with the vast majority of our people. As a result, they are impoverished because of high out-of-pocket healthcare expenditures. They also suffer the adverse consequences of the poor quality of care. Cases of medical negligence are on the rise; and unethical medical and nursing practices are also resorted to. The recent case of medical negligence of a private hospital in the capital shook the conscience of the nation and is testimony to the fact that even the corporate hospitals too are falliable.

Suggestions to improve healthcare:
• Focus on mass surveillance of 'at risk' and 'vulnerable populations' for non-communicable diseases like cancer, diabetes and hypertension.
• Well-planned system and policy for monitoring occupational health diseases and introduction of the concept of occupational health physicians and nurses by formulating post-graduate courses for the latter are needed.
• Provision of hazard identification units in industrial set-ups.
• Geographical coverage for endemic diseases.
• Introducing prevention-based health checkups at outpatient departments of every government health facility.
• Establishing a structured and well-organised referral system in the villages, providing comprehensive services on the concept of primary healthcare.
• Financial compensation to basic health workers working on population-based targets.

By: Dr. Vivek Rana