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Mains Answer Writing

23-March-2024

Q1) The enjoyment of the highest attainable standard of health is the fundamental right of every human being. In this perspective, examine the barriers to achieving universal health coverage in India by 2030.

(150 Words/10 Marks)

ANSWER

Universal health coverage (UHC) means that everyone should have access to the health services without suffering financial hardship. It is part of the Sustainable Development Goal 3 on Good Health and Well-being and is targeted to be achieved by 2030.

UHC is considered key to making the highest attainable standard of health as the fundamental right of every human being for the following reasons:

  1. UHC is needed to help the poor break free of vicious cycle of poverty.

E.g., high Out-of-Pocket Expenditure on health (66%).

  1. It addresses discrimination and exclusion based on factors like caste, ethnicity, gender etc.
  2. It helps in realizing the demographic dividend through improved learning-outcomes and improved productivity.
  3. Enhances access to other basic human rights

E.g., improved nutrition, better economic opportunities etc.

 While desirability of UHC is undoubtable, there are following barriers to achieving the same:

  1. There is poor doctor-to-patient ratio, especially in rural areas. There is also shortage of paramedical staff (1.96 nurses per 1,000 population). Accurate assessment of practicing physicians is also lacking.
  2. Poor public health expenditure (2.1% of GDP) as compared to countries like USA or UK (9-10% of GDP).
  3. There is bias towards urban-centred tertiary health infrastructure while primary health facilities are virtually absent.
  4. Discrimination against marginalised groups lead to their structural exclusion or even exploitation.

E.g., tribal women being duped into sterilisation for monetary compensation.

  1. Focus on supply of health could lead to overlooking of operational issues such as patients’ rights and issues of distrust.

E.g., incidents of violence against doctors.

 

Following suggestions can help overcome the impediments in achieving UHC:

  1. Address capacity augmentation in public health facilities through public-private partnerships.
  2. Improve accessibility in healthcare through tools such as digital health stack, tele-medicine etc.

E.g., Ayushman Bharat Digital Health Mission.

  1. NHP target for public health expenditure of 2.5% by 2025 needs to be increased. More ambitious development goals are needed for Amrit Kaal, the 25-year lead-up to India@100.
  2. Health workers should be trained for people-centric behaviour and attitude. It will help create responsible, responsive, and accountable health services and ethical health care.

It is the duty of the welfare state to improve nutrition, standard of living and public health under the directive principles of state policy (Article 47). Right to health is also inherent to right to life with dignity under article 21. While initiatives like Ayushman Bharat-National Digital Health Mission or

Right to Health Act in Rajasthan are steps in right direction, addressing issues of resource-constraint, ‘missing middle’ in health-insurance and discrimination will help to achieve UHC

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