It’s time to start a conversation on Universal Health Coverage in India

Impact Guru
Dec 2, 2017 · 5 min read

Dr. Saumya Swaminathan, a pediatrician and scientist, created history by being the first Indian to hold the esteemed Deputy General position at the World Health Organization.

Daughter of MS Swaminathan, who spearheaded the Green Revolution in India, Saumya will be occupying the second highest position at the WHO. Her appointment, perhaps, comes as irony and as an intimation for India to start taking its healthcare policies more seriously.

Dr. Swaminathan has more to her credit than we can list here. She is a pediatrician and a globally-recognised researcher on tuberculosis and HIV, who has over 30 years of experience in clinical care and research.She was earlier the Director of the National Institute for Research in Tuberculosis, Chennai and is currently serving as the Director General of the Indian Council for Medical Research (ICMR), an apex body in India for biomedical research. Apart from this she has also been serving as the Secretary of the Department of Health Research for the Ministry of Health and Family Welfare, Government of India.

Dr. Swaminathan has been on various global advisory bodies such as the WHO Expert Panel to Review Global Strategy and Plan of Action on Public Health, Innovation and Intellectual Property, the Strategic and Technical Advisory Group of the Global TB Department at WHO, and as co-chair of the Lancet Commission on TB.

Between 2009 and 2011, she coordinated work on tropical diseases, between the UNICEF , UN Development, the World Bank and the WHO.

With this much to her credit, it is Swaminathan’s current focus that should be of interest to India — Universal Health Coverage. The idea of UHC has been doing its rounds however, it has been backbenched to other policies and in some way, we hope, her appointment starts a conversation that would help make UHC a vibrant reality.

Swaminathan has been vocal about her support for UHC. “Universal health coverage is a very clear goal, for India and for other countries. UHC takes care of a lot of health issues and we have to work towards it”, she affirmed in her interview with Indian Express.

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The United Nations Sustainable Development Goals that all UN Member States (including India) have agreed to entail enforcing a Universal Health Coverage by 2030. This includes financial risk protection, access to essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all.

On India’s progress on rolling out universal health coverage, Dr. Swaminathan said,

“Our commitment to UHC is enunciated in the National Health Policy; we have accepted that it is the path forward. We have already moved forward on some components — conversion of sub-centres into health and wellness centres is one crucial step because promotion of preventive and promotive healthcare is a key component of UHC. Health assurance in some form will have to be brought, at least for people living below the poverty line, the ones who are most vulnerable. Some states are already doing it at their levels. The challenge is to roll it out nationally.”

However, she also highlights the loopholes in the implementation of the proposed universal health coverage. According to her one of the biggest gaps in Indian Healthcare, where she would want to leverage her position to nudge India to move ahead, is bringing preventive and promotive healthcare (awareness drives and free vaccinations for preventable diseases) under the ambit of UHC.

Universal Health Coverage has been a topic of heated debate since the last decade in India. However, a little has been done towards achieving this goal. The reports on UHC, on the National Health Portal of India committed to roll out UHC by the end of the 12th five year plan (i.e. by 2017). However, it has taken a backseat with realignment of goals and abolition of five year planning system by the new government. The country that has always wanted to march towards a welfaristic model of governance with emphasis on socialism, has consistently neglected this important sector.

India is a land of contrasts and its provision of healthcare is no different. On one hand we have made rapid progress in medical technology, and have skilled doctors to the extent that we are promoting medical tourism to the developed world, while on the other hand 70% of India’s population in rural areas has limited access to quality healthcare facilities. Even in urban areas the healthcare facilities are not enough to take care of the country’s increasing requirement. It takes a simple Google search to show you the ailing healthcare system of India. According to World Bank statistics, there are 0.5 beds per 1000 people and 0.2 doctors per 1000 patients in our country

India has been widely criticised for having one of the world’s lowest public spending on health (4% of GDP as per World Health Organization Global Health Expenditure database). To make matters worse, there is very low insurance penetration, at around 17%. As a result India has one of the highest out-of-pocket expenditure at 61%. In comparison out-of-pocket expenditure is much lower at 34% in China and 11% in the US. Over 63 million people in India are pushed to poverty every year due to health care costs.

Universal Health Assurance is not impossible to achieve for this country that has made tremendous progress in reproductive, maternal, child and adolescent health, universal immunization, achieved eradication of diseases like polio. But for this to happen, the government needs show the political will to mandate health as a fundamental public good, central to India’s developmental ambitions, on par with progress in other sectors.

The starting point would be incorporating ‘Right to Health’ under the ambit of article 21 of the Indian Constitution, that ensures ‘Right to Life’, as it has already been interpreted several times by the Judiciary.

Taking it further, India can follow the Cuban model which is recognized worldwide for its excellence and its efficiency. Despite extremely limited resources and the dramatic impact caused by the economic sanctions imposed by the United States for more than half a century, Cuba has managed to guarantee access to care for all segments of the population and obtain results similar to those of the most developed nations.

Thus, India too can achieve UHC with limited resources. In fact, India’s Ministry of Health has estimated that rolling out UHC will cost approximately $6.5 billion per year for four years (2015–19). India’s current GDP is estimated at $2.25 trillion by the World Bank. Consequently, the cost of rolling out UHC is actually only 1% of India’s GDP.

Cuba’s healthcare system is based on preventive medicine and the results achieved are outstanding. This is similar to what Dr. Swaminathan has stressed in her interview. It is evident that Indian medical practitioners and policy analysts have their priorities and plans sorted out already. It is only political will that can take us towards a healthcare policy that will help save lives in time.

Written by Maithili Pradhan.

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