Ayushman Bharat Programme has components to increase accessibility, availability and affordability of healthcare facilites. A fast track and successful implementation of this programme has potential to accelerate India’s progress towards Universal Health Coverage (UHC), writes Chandrakant Lahariya, National Professional Officer, Universal Health Coverage, World Health Organisation, India, for Elets News Network (ENN).
The constitution of the World Health Organisation (WHO) came into force on 7 April, 1948, the day which is now globally commemorated as the World Health Day. Every year, WHO selects a theme for the World Health Day (WHD). The theme of WHD2018 is ‘Universal Health Coverage: everyone, everywhere” and slogan is #HealthForAll. Throughout 2018, WHO aims to ‘inspire, motivate and guide’ stakeholders to make commitments towards universal health coverage (UHC).
The UHC aims that ‘all people have access to needed promotive, preventive, curative and rehabilitative health services, of sufficient quality to be effective, while also ensuring that people do not suffer financial hardship when paying for these services’.
In the recent times, UHC received global attention as an idea and aspiration with the WHO’s World Health Assembly 2005 resolution.
This was further reinforced by the United Nations General Assembly (UNGA) resolution passed on UHC on 12 December 2012. The UNGA resolution was a landmark step as it broadened the scope of UHC agenda from the ambit of Health Ministers to the heads of the State and Ministers of Foreign Affairs, who are part of UNGA. To commemorate UNGA resolution on UHC, 12 December is now globally commemorated as UHC day.
Understandably, the UHC has found a place in Sustainable Development Goals (SDGs) agenda as well as health goal 3 (or SDG-3). A specific target in SDG-3 on UHC is often considered overarching for all other targets in the health goal. Among experts and academicians, the UHC is largely well understood. However, to make substantial progress in this direction, it needs to be understood, equally well, by elected representatives and common men/women.
Let’s understand what achieving UHC would mean to a poor and elderly widow living in a tribal village in India.
To her, UHC would mean that she can have access to desired health services within acceptable distance and time frame. Her decision to seek healthcare services and the choice of selecting a health facility would not depend upon health problem, place of living, or income level. She would have enough choice of providers and when she would need specialist care, it would be facilitated by the first level of providers.
When availing the health services from licensed providers, she would not have to worry about the quality and would have reasonable assurance that the Government would have mechanisms in place to ensure quality of services. Her decision to use health services would not be dependent upon her financial status and she would have sufficient confidence that access to services would be within her financial affordability and the use of health services would not make her poor.
Programmatically, Universal Immunisation Programme (UIP) in India could be used as a good analogy to explain what it might mean with UHC. Under UIP in India, the Government offers a select number of vaccines to all children across the country. The additional vaccines are available in the private sector on payment basis. The vaccines in UIP are delivered through designated health facilities.
The quality of these vaccines and services from all providers is regulated and assured by the Government. People make a free choice to get their children vaccinated at one of the facilities – either in public or the private sector. Majority of the parents prefer the Government facilities for vaccination.
However, a few choose private sector. If they attend the Government facilities, the vaccines are free for them. However, they have to pay for these vaccines, and also for the vaccines which are not a part of the Government programme, if they choose to get their child vaccinated at a private facility. With this, nearly 85-90 per cent of vaccination services are delivered by the Government providers. There is no evidence or indication that any family has ever become poor due to access to vaccination services.
However, UHC should not be confused with a single programme or scheme and it is not meant to achieve UHC for immunisation or UHC for tuberculosis. It is about agreed essential packages, which can cater majority of health needs of the population. UHC also ensures that people do not have to choose between buying basic needs of life such as food or accessing the needed health services. UHC is about increasing accessibility, availability of health services and providing appropriate care for the people. The countries should aim to achieve UHC in the time-bound manner.
The Government of India has recently announced ‘Ayushman Bharat Program’, which has components to set up 1,50,000 health and wellness centres (HWCs) to provide a broad range of primary healthcare services. It has provision to provide financial coverage of up to Rs 5,00,000 for nearly 100 million families for the cost of secondary and tertiary level hospitalisation through National Health Protection Mission (NHPM). This program has components to increase accessibility, availability and affordability of all three types of health services (primary, secondary and tertiary) in India. Therefore, a fast track and successful implementation of Ayushman Bharat program has potential to accelerate India’s progress towards UHC.
The WHD2018 provides another opportunity to make commitment towards universal health coverage in India. What the Governments at both national and state levels and other stakeholders (including government and citizen) will do collectively, now and in the time ahead, will determine the health status and healthseeking behaviour of that old tribal widow woman in a faraway remote village in India.
The day, when she would not have to worry about health services, would be the day when the country (India) can boast to have achieved Universal Health Coverage.