“Universal Health Coverage in India: Navigating Challenges and Harnessing Opportunities”
Have you ever wondered, with the advent of technology, how we can now access anything at our doorsteps so easily? IT Innovation has revolutionized even the most complex, and human services like healthcare become accessible. The World Health Organization reports over 7 billion telephonic and online subscriptions worldwide, with more than 70% in low- or middle-income countries using these platforms to access healthcare facilities. However, the rise of tech services and modernization has also introduced new challenges. The complexity of medical examinations and appointment processes, driven by various protocols often makes it difficult for people to receive medical services.
According to the World Health Organization (WHO) and the World Bank published report, Universal Health Coverage (UHC) Global Monitoring, 2023, revealed an alarming stagnation in the effort to provide quality, and reasonably priced healthcare to people worldwide. Countries worldwide are concentrating on Universal Health Care to respond to these challenges and ensure that people won't suffer anymore.
Why UHC?
The UHC concept got its limelight during Covid- 19 pandemic, many cases were reported of individuals losing loved ones due to the prohibitive cost of beds and vaccines, coupled with shortages of essential supplies like oxygen concentrators. The UHC initiative was set to provide all demographic groups full access to healthcare facilities without financial hardships.
Countries have taken a step forward in their national health systems by pooling funds so that the cost of healthcare is shared equally across society. Many countries like Canada, the UK, and Switzerland are working for public welfare schemes that sponsor full 100% medical facilities to especially dependent citizens like children and elders. Its primary goal is to improve every Primary Health Centre facility accessible to the local communities.
But do you believe it is feasible to implement universal health care in densely populated countries like India?
Challenges in attaining Universal Health Care in India
Over exploded Population
Managing and resolving health challenges is relatively straightforward in areas with fewer people. However, in highly populated nations, addressing these issues becomes significantly more complex due to the sheer volume of individuals and the strain on resources. Cities like Mumbai and Delhi have more than 20,000 people per square km. About 45% of people reside in densely populated metropolitan regions, where common illnesses include skin conditions, waterborne infections, poor cleanliness, and other issues that put risk on the sustainability of life.
The WHO recommended 3.5 beds per 1,000 people (on average) but a survey conducted in 2022 revealed an average of just 0.7 beds per 1,000 persons. "India is facing a deficit of 2 billion sq. ft of healthcare space to cater to its current population base of 1.42 billion people" Knight Frank India said in their report in 2023.
Limited Health Care Facility
India’s healthcare system is a tapestry of both progress and disparity. On the one hand, government programs made health services more accessible for many people. On the other hand, In India, as per government standards, there is a clear disproportion of access to healthcare between rural and urban areas, with only 27% of the population receiving care from the 75% of health infrastructure concentrated in metropolitan areas.
According to the 2011 census, 68.84% of people live in rural areas. Closely 86% of all medical visits in India are done by rural residents, with the majority still traveling more than 100 kilometres to access healthcare facilities, 70% to 80% of these costs are covered personally, driving individuals into needless financial distress.
Imagine if PHCs were established in rural areas with adequate infrastructure money spent on transportation could have been saved.
The strain on elderly & middle class and financial drawbacks
Inflation and rising costs of medical services have made its accessibility increasingly difficult for the middle class. Despite the availability of services, high fees and taxes on medical services force many patients to delay or skip necessary check-ups. Out-of-pocket health expenses for Indian patient are alarmingly very high, accounting for 62% of total health expenditure, which they cover entirely on their own. Even more shocking, it doubled the public spending by Central and State governments. Additionally, 67% of Indians' healthcare spending goes solely toward medicine. This issue is particularly severe for the elderly aged people, they struggle to navigate the healthcare system, leading to significant challenges in receiving timely medical care.
Government’s response
To achieve universal healthcare, the Indian government has significantly increased its budget, allocating Rs. 87,656.90 crores to the Department of Health and Family Welfare for FY 2024-25, a 12.93% rise from the previous year. Key initiatives like the National Digital Health Mission, allotted Rs 200 crore dedicated to creating a strong digital health ecosystem that supports universal health coverage country-wide. Ayushman Bharat Yojana focuses on comprehensive primary healthcare services and fitness awareness, while Pradhan Mantri Jan Arogya Yojna aims to strengthen healthcare access to economically underprivileged people.
On the other hand, the government is working on their upcoming project U-WIN (to be launched soon in 2024), which aims to digitize vaccination records of children up to 6 years old and pregnant females. The digital vaccine card will enhance maternal and child care by notifying parents of upcoming medical checkups, past vaccinations, and medical tests. Replacing ASHA vaccination cards, U-WIN will revolutionize primary healthcare at the grassroots level.
Universal health coverage will boost the access, equity, and quality of health services. This strategy provides the entire framework through which all health professionals can continue to deliver their services to patients effectively at all levels of need. For example, India had to fight the COVID-19 pandemic by vaccinating its highly dense population. The vaccination process was aided by the COWIN online portal because vaccination records could easily be kept on track.
Similarly, to ensure 100% success with UHC, the government must tailor its strategies to India's unique landscape. One effective measure could be linking AADHAAR cards with medical records, similar to their use in banking. Establishing a monitoring team or department, would enable precise health monitoring and help align with UHC’s primary goal.
Digital tools such as electronic health records, appointment scheduling apps, and telemedicine can aid in rendering patient care smoother. Such technologies will allow health professionals to manage a patient's record, schedule an appointment, and even remote consultations, thereby improving access to and quality of care that will particularly benefit remote or underserved areas with limited access to conventional healthcare facilities.
Such collaboration is necessary with the policymaker to ensure that universal healthcare is implemented successfully. Development of schemes on health and patient-centered approaches; working together in execution will make sure that gaps in healthcare are covered and quality care reaches all, including people in underserved regions.
UHC is not just a goal for India but it has become a necessity for equitable development. By focusing on each individual, every small effort contributes to making our nation self-sufficient in healthcare.
(The author of this article is Dr. PR Sodani, President, IIHMR University)
