13 December 2024 : Indian Express Editorial Analysis

1. Healthcare, more responsive      

(Source: Indian Express; Section: The Editorial Page; Page: 12)

Topic: GS2 – Social Justice – Health

Context

The article examines the challenges and prerequisites for achieving Universal Health Coverage (UHC) in India, emphasizing the need for equitable governance, increased investment, and systemic reforms in healthcare.

What is Universal Health Coverage?

• It means that all people have access to the full range of quality health services without financial hardship. 
• Key components of UHC include:
• Access to Care: Everyone should be able to obtain necessary health services when they need them.
• Quality Services: The care provided should be effective, safe, and of good quality.
• Financial Protection: Individuals should not face financial difficulties due to medical expenses. 
• Achieving UHC is one of the targets the nations of the world set when they adopted the 2030 Sustainable Development Goals (SDGs) in 2015.

The Philosophical Underpinnings of UHC

• Universal Health Coverage (UHC) is rooted in the principle that every individual deserves access to quality healthcare, promoting equality and dignity.
• However, India’s fragmented society and politics often lack the egalitarian ethos that UHC demands.
• Despite India’s intellectual traditions, ideas of equality have not gained substantial political traction.
• For UHC to become a reality, the political system must embrace equality and justice as core tenets.
• Health, intrinsically linked to politics, reflects competing interests, and achieving UHC would require aligning these interests with societal welfare rather than narrow agendas.

Policy Requirements for UHC

To actualize UHC, India must undertake several interconnected policy actions:

• Increased Health Funding: Doubling health expenditure is essential to bridge the resource gap for comprehensive primary healthcare.
• Addressing Social Determinants of Health: Ensuring universal access to nutrition, clean water, sanitation, education, and income security is foundational.
• Human Resource Development: Training and deploying skilled personnel across all levels of care is critical to strengthening the healthcare system.
• Provider Accountability: Establishing incentive structures that make healthcare providers accountable to the people they serve is imperative.
• Governance of the Private Sector: Oversight and regulation of the burgeoning private healthcare sector are necessary to protect patients from exploitative practices.

Strengthening the health system requires more than infrastructure development. It demands robust governance, regulatory frameworks, and an interventionist state to guarantee care based on need, mitigating the market’s imperfections.

India’s Health Achievements and Challenges

• India has made commendable progress in public health, including the eradication or control of several communicable diseases and significant reductions in maternal and infant mortality.
• However, the epidemiological transition has shifted the burden to non-communicable diseases (NCDs) such as cardiac ailments, cancers, diabetes, and COPD, which now account for 60% of mortality.
• These conditions, influenced by lifestyle changes and ageing, demand a transition from episodic to long-term care.
• Reshaping the health system to accommodate this shift necessitates resilience, skilled personnel, and a focus on preventive and community-based care.
• Investments in primary care, such as those under the Ayushman Bharat programme, can reduce hospitalisations and associated costs, highlighting the economic value of preventive healthcare.

Persistent Issues in India’s Health System

Despite significant achievements, several systemic issues hinder progress toward UHC:

• Underfunding of Public Health: Public health spending has stagnated at 1-1.3% of GDP, far below the WHO’s recommended 3%. This underinvestment results in suboptimal public health facilities and high out-of-pocket expenditures, which remain between 45-54%, against the SDG target of 20%.
• Human Resource Challenges: Persistent vacancies, especially of specialists at Community Health Centres (CHCs), exacerbate inequities. The lack of skilled personnel forces patients to seek expensive private care or overcrowded district hospitals.
• Privatisation and Corporatisation: The private sector’s growing corporatisation has led to commercialisation, over-diagnosis, and unnecessary procedures. Foreign investments in tertiary care hospitals prioritize profits, inflating healthcare costs.
• Erosion of Public Healthcare Access: Leasing district hospitals to corporates limits access to affordable care for the middle class, reflecting the government’s diminished role in healthcare governance.

The Path Forward

Achieving UHC in India requires a paradigm shift in governance and resource allocation. Viewing UHC as merely health insurance provision is reductive; the state must prioritize building a robust healthcare delivery system with quality and accessibility at its core. Key measures include:

• Increased Investments: Allocating sufficient funds to improve infrastructure and service delivery.
• Strengthened Governance: Enforcing regulations to prevent profiteering and ensure accountability.
• Community Engagement: Elevating public aspirations and holding the political system accountable for delivering health as a public good.

Conclusion

• Universal Health Coverage is a realistic aspiration for India, but it demands a reorientation of political priorities toward equity and justice.
• The state must play an active role in governing the healthcare system, addressing resource gaps, and creating accountability frameworks. Without these foundational changes, UHC will remain an elusive ideal.
• The challenge lies in fostering a political and societal consensus that places health and welfare above short-term gains, ensuring that healthcare becomes a universal right rather than a privilege.

UHC in India

Constitutional Provisions: The Directive Principles of State Policy in Part IV of the Constitution provides a basis for the right to health. Article 39 (e) directs the state to secure the health of workers; Article 42 emphasises just and humane conditions of work and maternity relief; and Article 47 casts a duty on the state to raise the nutrition levels and standard of living, and to improve public health.  The Constitution also endows the panchayats and municipalities to strengthen public health under Article 243G. India’s National Health Policy of 1983 recognized the goal of “Health for All” and emphasized the importance of primary healthcare and equitable distribution of healthcare resources. Currently, India aims to attain UHC through the expansion of the Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (AB-PMJAY), the flagship publicly financed health insurance (PFHI) scheme of the Union government.

PYQ: With reference to the National Rural Health Mission, which of the following are the jobs of ‘ASHA’, a trained community health worker? (2012) 1) Accompanying women to the health facility for antenatal care checkup 2) Using pregnancy test kits for early detection of pregnancy 3) Providing information on nutrition and immunisation. 4) Conducting the delivery of baby Select the correct answer using the codes given below: (a) 1, 2 and 3 only (b) 2 and 4 only (c) 1 and 3 only (d) 1, 2, 3 and 4 Ans: (a)

Practice Question: Critically analyze the feasibility of achieving Universal Health Coverage (UHC) in India. Discuss the key challenges and reforms needed to make UHC a reality. (250 words/15 m)