Progressing Towards Universal Health Coverage

Syllabus: GS2/Health/Governance

Context

• Eight years ago, Ayushman Bharat was rolled out with the idea that every Indian should have access to top-quality and affordable healthcare.

About

• The Government launched the Ayushman Bharat Pradhan-Mantri Jan Aarogya Yojana (AB PM-JAY) in 2018.
• Aim: To achieve universal health coverage. 
• It is a public health assurance scheme and covers secondary and tertiary care. 
  • It is one of the world’s largest public healthcare schemes, with about 33% of India’s population  (over 48.51 crore people) already holding Ayushman cards.

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. 
• UHC is rooted in the universal human right to health, affirmed in international covenants and the Alma-Ata Declaration (1978), which prioritised comprehensive primary healthcare.

Need For Universal Health Coverage in India

• High Out-of-Pocket Expenditure: A significant share of healthcare spending is borne directly by households, which can push vulnerable families into financial distress.
• Unequal Access to Healthcare: Rural, tribal and remote areas often face shortages of doctors, specialists, diagnostic facilities and quality hospitals, creating geographical disparities.
• Large Disease Burden: India faces a dual burden of communicable and non-communicable diseases, requiring accessible preventive, primary and specialised healthcare.
• Preventive and Primary Healthcare: UHC can shift the focus from expensive hospital-based treatment towards prevention, early diagnosis and primary healthcare, reducing the burden on tertiary facilities.
• Demographic and Epidemiological Transition: With an ageing population and increasing prevalence of chronic diseases, India needs sustainable access to long-term and affordable healthcare.

Constitutional Basis for UHC:

• 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.

Challenges in Adopting UHC in India

• Resource Constraints: India faces significant funding limitations in healthcare, with a low public health expenditure compared to many other countries. This affects the ability to provide comprehensive services.
• Infrastructure Gaps: Many areas, especially rural regions, lack adequate healthcare infrastructure, including hospitals, clinics, and trained personnel, making access to care difficult.
• Healthcare Workforce Shortages: There is a shortage of healthcare professionals, particularly in rural areas, leading to disparities in access and quality of care.
• Fragmented Health Systems: India’s healthcare system is a mix of public and private providers, leading to inconsistencies in quality and accessibility.
  • And, Health is a State subject, while financing and flagship schemes are centrally driven, leading to uneven outcomes.

Conclusion

• AB-PMJAY expands access to quality and affordable secondary and tertiary healthcare for eligible beneficiaries, while Ayushman Aarogya Mandirs bring comprehensive primary healthcare closer to communities. 
• ABHA (Ayushman Bharat Health Account) enables individuals to create a unique digital health identity and access their health records across participating healthcare facilities. 
• PM-ABHIM strengthens the health system’s infrastructure and preparedness by supporting the development of health centres, laboratories, and critical care facilities from the grassroots to the district level.
• These initiatives strengthen the continuum of healthcare, from primary care and digital health services to hospital-based treatment and resilient health infrastructure.

Source: PIB