By Dr Chandrakant Lahariya
December 12 is commemorated as Universal Health Coverage Day, globally. The Universal Health Coverage (UHC) aims that all people have access to needed promotive, preventive, curative and rehabilitative health services, of sufficient quality to be effective, while also ensuring that people do not suffer financial hardship when paying for these services.
Landmark resolution
Though, not entirely a new concept, the UHC received global attention as an idea and aspiration with the World Health Assembly 2005 resolution. It urged the member states to develop their health financing systems for transitioning to UHC. This was further reinforced by the United Nations General Assembly (UNGA) resolution passed on UHC on 12 December 2012. The UNGA resolution was a landmark step as it broadened the scope of UHC agenda from the ambit of health ministers to the heads of state and ministers of foreign affairs. To commemorate UNGA resolution on UHC, this day is now globally commemorated as UHC day. Understandably, the UHC has found a place in Sustainable Development Goals (SDGs) agenda as well health goal 3 (or SDG-3). A specific target in SDG-3 on UHC is often considered overarching for all other targets in health goal.
Long journey for India
There is a long journey towards UHC in most low and middle-income countries. A few months ago, the reputed medical journal The Lancet reported that in terms of healthcare services Index, India was ranked at 154 out of 195 countries. In India, the accessibility to services is limited due to a multitude of reasons: geographical, financial and cultural barriers, to list a few. The quality of health services delivered is unknown or poor. Unqualified people providing services is a common challenge. People are overcharged while accessing services. The government has acknowledged in new national health policy that every year 6.3 crore people fall into poverty due to health-related expenditure. Those who were already below poverty line fall deeper into poverty. Health-related expenditure is partially undoing governments interventions to alleviate poverty. Clearly, India is not doing very well on health services and it earnestly needs to take steps to move towards UHC.
Among experts and academicians, the UHC is largely well understood. However, to make substantial progress in this direction, it needs to be understood, equally well, by elected representatives and common man/woman.
Perks of UHC
To a poor, old, widow living in a tribal village in India, UHC would mean that she can have access to desired health services within acceptable distance and time frame. Her decision to seek healthcare services and the choice of selecting a health facility would not depend upon health problem, place of living, or income level. She would have enough choice of providers. When she would need specialised care, it would be facilitated by the first level of providers. When attending the health services from licensed providers, she would not have to worry about the quality. She would have reasonable assurance that government would have mechanisms in place that she receives good quality services. She would have sufficient confidence that access to services would be within her financial affordability and the use of health services would not make her poor.
Vaccination programmes
Programmatically, Universal Immunisation Programme (UIP) in India could be used as a good analogy to explain what it might mean with UHC. Under UIP in India, the government offers a select number of vaccines to all children in the country. The additional vaccines are available in the private sector on payment basis. The vaccines in UIP are delivered through designated health facilities. The quality of these vaccines and services from all providers is regulated and assured by the government. People make a free choice to get their children vaccinated at one of the facilities – either in public or the private sector. Majority of the parents prefer government facilities for vaccination. However, a few choose private sector. If they attend government facilities vaccines are free. However, they have to pay for these vaccines, and also for the vaccines which are not a part of the government program, if they choose to get their child vaccinated at a private facility. There is no evidence or indication that any family has ever become poor due to vaccination services.
However, UHC should not be confused with a single programme or scheme and it is not meant to achieve UHC for immunisation or UHC for tuberculosis. It is a holistic concept for an agreed minimum essential package for a large enough segment of the population. It is to be done in an incremental fashion to reach entire population in a time-bound system.
The path ahead
India has been at the forefront of policy discourse and has done some background work. It seems to be ready to take a giant leap towards UHC. The National Health Policy of India (2017) has possibly the most explicit statement of intent to advance UHC in the country. The Union and state governments in India are considering mechanisms to ensure that people do not become poor while accessing health services. However, the Indian governments are not known for translating policy into actions. Achieving UHC would need more rapid policy to implementation transition. 12 December, the UHC day, provides that opportunity. What we do collectively today and in the time ahead will determine the health status and health-seeking behaviour of that old tribal widow woman in a faraway remote village in India. The day, when she would not have to worry about health services, would be the day when the country can consider to have achieved Universal Health Coverage.
(Views are personal)
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