Universal Health Care/Coverage (UHC)

Context:  The Universal Health Care must encompass primary, secondary and tertiary care for all without discrimination.

What is Universal Health Care/coverage (UHC)?

• Definition: Universal health coverage (UHC) means that all people have access to the full range of quality health services they need, when and where they need them, without financial hardship.
• Coverage: It covers essential health services, from health promotion to prevention, treatment, rehabilitation, and palliative care across the life course.
  • Every country has a different path to achieve UHC and decide what to cover based on the needs of their people and the resources at hand.
• SDG: Achieving UHC is one of the targets under the 2030 Sustainable Development Goals (SDGs).
  • WHO’s Thirteenth General Programme of Work aims to have 1 billion more people benefit from UHC by 2025.
• Prerequisites: UHC requires strong, people-centred primary health care. Good health systems are rooted in the communities they serve.
  • They focus not only on preventing and treating disease and illness, but also on helping to improve well-being and quality of life.
• Significance & Benefits:
  • UHC enables the people to access the services that address the most significant causes of disease and death, and ensures that the quality of those services is good enough to improve the health of the people who receive them.
  • Protecting people from the financial consequences of paying for health services out of their own pockets reduces the risk that people will be pushed into poverty.

What are some Global Initiatives for UHC?

• Astana Declaration (2018): The Global Conference on Primary Health Care in Astana, Kazakhstan aims to refocus efforts on primary health care to ensure that everyone everywhere is able to enjoy the highest possible attainable standard of health.
  • The declaration was signed by all 194 WHO member states including India.
• UHC 2030: It provides a multi-stakeholder platform to promote collaborative working at global and country levels on health systems strengthening.
  • UHC 2030’s strategic focus is to mobilize political commitment and collective action for UHC.
• P4H Social Health Protection Network: P4H network promotes active exchanges and collaborations between the various health financing stakeholders at national and global level.
  • The P4H network is the only global institutional network specialized in health financing.
  • It is currently comprised of 18 members including WHO, World Bank and ILO.
• SDG3 GAP: The Global Action Plan for Healthy Lives and Well-being for All (SDG3 GAP), established in 2019, brings together 13 multilateral health, development and humanitarian agencies.
  • Its goal is to help countries accelerate progress on the health-related Sustainable Development Goals (SDGs) targets, through a set of commitments.

What are the Routes to Achieve UHC?

• UHC typically relies on one or both of two basic approaches: public service and social insurance.
  • Public Service: In this approach, health care is provided as a free public service, just like the services of a fire brigade or public library.
  • Social Insurance: The second approach (social insurance) allows private as well as public provision of health care, but the costs are mostly borne by the social insurance fund(s), not the patient.

What are the Challenges to UHC?

• Lack of Public Health Centres: In a system based on social insurance, public service plays an essential role.
  • The absence of public health centres, dedicated to primary health care and preventive work, creates the risks of patients rushing to expensive hospitals, thus making the whole system wasteful and expensive.
• Containing Costs: Containing costs is a major challenge with social insurance, because patients and health-care providers have a joint interest in expensive care.
  • A possible remedy is to make the patient bear part of the cost but the idea conflicts with the principle of UHC.
• Identifying Services under UHC: Identifying what services are to be universally provided to begin with and what level of financial protection is considered acceptable is a major challenge.
  • Offering the same set of services to the entire population is not economically feasible and demands huge resource mobilisation.
• Regulation of Private Sector: Another problem with social insurance is to regulate private health-care providers. A crucial distinction needs to be made between for-profit and non-profit providers.
  • Non-profit health-care providers have done great work around the world.
  • For-profit health care, however, is deeply problematic because of the conflict between the profit motive and the well-being of the patient.

What are India’s Initiatives for UHC?

• National Health Mission (NHM): NHM was launched by the Union Government in 2013 subsuming the National Rural Health Mission (2005) and the National Urban Health Mission (2013).
  •  Main components:
    •  Health System Strengthening
    •  Reproductive-Maternal- Neonatal-Child and Adolescent Health (RMNCH+A)
    •  Communicable and Non-Communicable Diseases
  •  NHM envisages achievement of universal access to equitable, affordable & quality health care services that are accountable and responsive to people’s needs.
• Saksham Anganwadi & Poshan 2.0: Saksham Anganwadi and Poshan 2.0 is an Integrated Nutrition Support Programme.
  • It seeks to address the challenges of malnutrition in children, adolescent girls, pregnant women and lactating mothers through a strategic shift in nutrition content and delivery and by creation of a convergent eco-system to develop and promote practices that nurture health, wellness and immunity.
  • Components:
    • Nutrition Support for POSHAN through Supplementary Nutrition Programme (SNP);
    • Early Childhood Care and Education [3-6 years] and early stimulation for (0-3 years);
    • Anganwadi Infrastructure including modern, upgraded Saksham Anganwadi; and
    • Poshan Abhiyaan aims to reduce stunting, undernutrition, anaemia and reduce low birth weight by 2%, 2%, 3% and 2% per annum respectively.
• National Food Security Act (NFSA): The Union Government provides food grains at low cost under the NFSA.
  • The act aims to ensure people’s food and nutritional security by assuring access to enough high-quality food at reasonable prices.

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