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Universal Health Coverage for India?

These are exciting times for health care reform in India. Last year in his Independence Day Address the Prime Minister declared that health would be accorded the highest priority. Going a step further, the government outlined plans to increase public financing of health from 1.2% of India’s GDP to 2.5% and there have been many recent press statements on this. Of course actions will speak louder than words.

In November 2011 the High Level Expert Group submitted its report to the National Planning Commission, describing a vision where every citizen should be entitled to essential healthcare services that will be guaranteed by the Central government. The report shows how it is feasible for India to establish a UHC system within the next ten years. In response the PM has let it be known that he wants the Planning Commission to take steps to help the government offer free universal health care, as proposed by the group.  Very welcome plans are already apparently in motion  to provide free medicine for all through Public Health Facilities under the National Rural Health Mission.

The Public Health Foundation of India has just launched a dedicated website to drive forward progress on Universal Health Coverage (UHC) in India. The website showcases the recent groundbreaking report of the Planning Commission’s High Level Expert Group on Universal Health Coverage. It features background documents, commentary, and expert interviews and serves as an interactive space for UHC publications as well as national and global events.

The High Level Expert Group report includes the following key recommendations:

  • Increase public expenditures on health to at least 2.5% by the end of the 12th plan, and to at least 3% of GDP by 2022
  • Ensure availability of free essential medicines by increasing public spending on drug procurement
  • Expenditures on primary health care should account for at least 70% of all health care expenditures
  • Use general taxation as the principal source of health care financing
  • Do not levy fees of any kind for use of health care services under the UHC
  • Do not go the insurance route – all government funded insurance schemes should be integrated with the UHC system.

The UHC India website could not have been launched at a more appropriate moment. This month the National Advisory Council, led by Sonia Gandhi, will consider the recommendations of the High Level Expert Group, which is indicative of a key milestone in the push for a system where all Indian citizens, regardless of their economic, social or cultural backgrounds will have the right to affordable, accountable and appropriate health services.

For UHC to succeed political and financial commitment will be essential and much hard work is needed. This new website is an excellent resource for anyone committed to making this aspiration a reality.

 

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4 Responses to “Universal Health Coverage for India?”

  1. A very useful Information on medical Insurance.

  2. Sam Lanfranco says:

    As someone who has spent the past twenty-two years working with ground level Dalit groups while they try to secure the rights and protections that Ambedkar helped enshrine in the Indian Constitution of half a century ago, I would suggest that this posting by Anna Marriott should have said “inactions will unfortunately speak louder than promises”. To pass promising legislation is one thing. To actually implement it is quite another. While hope springs eternal, there is abundant evidence to sadly support doubt in this initiative.

  3. Dr. Sumeet Singh says:

    Should we hope a dawn in public health in INDIA ?

    As now are the budgetry days in India, lots of talks are there on the issues of strenthening public health and education system. Some media reports are there about the possible Health System Reforms.

    Although we will only know how our worthy planners and ministers have planned to take care of our healh in the next year on the Budget day, I just want to review the direction of government on perspective of health in recent past. Congratulations to government and health departrment on the fronts of Polio and AIDS, but what about failure in implementation of schemes of NRHM, mismanagement of funds in NRHM, Lack of monitoring and coordination of different programs at district and higher levels.

    The major problem in health care provision as per the govt. is lack of health care providers, out of which serious concern is shortage of doctors in public health system in rural areas. Although some states like Tamil Nadu,Punjab ,Kerala and Gujarat have managed to tackle this problem thanks to better infrastructure and overall development of the state as whole but on national aspect it has been a major concern for the last two Union Health ministers which has lead them to create a brand new medical study course for rural medical science, the final shape of which we are unaware of till now.

    But here rises a big question, that do we really so badly require thousands of new health care providers when we are not using the existing manpower to its full potential ? As a part of the health care delievery system I have obseved that although we talk about overburden on govt. hospitals but it is only at the level of large tertiary care hospitals and few District level hospitals while majority of the block level community health centres (CHC) and primary health centres(PHC) where doctors are available remain non- functional due to lack of interest of doctor itself, lack of monitoring/ false reporting and if doctor is willing to do justice to his work gets limited by lack of supporting staff, laboratory facilities, medicines or pathetic atmosphere of workplace thanks to ego clashes among doctors. The Patient which can be easily managed at these centres now move to higher centre leading on to overburden there and again limiting the quality of health care. Is it not more important to first focus on these issues and making these units functional upto their maximum potential ?

    A total of 1 .6 lakh subcenters, (with 1.27 lakh Health workers in position) and 22975 PHCs and 2935 CHCs (with over 24000 doctors and over 3500 specialists to serve in them) have been set up. The PHC approach as implemented seems to have strayed away from its key thrust in preventive and public health action. No system exists for purposeful community focused public information or seasonal alerts or advisories or community health information to be circulated among doctors in both private practice and in public sector. PHCs were meant to be local epidemiological information centers which could develop simple community. Civil Surgeons and panels have no active role in pre planning and preventive advisory until the epidemic has already occurred. Majority of Medical Officers can’t even count the various national health programs running in their own districts. No estimates are being provided to them regarding disease burden in their area of PHC. How can a newly recruited Medical officer will perform until he is being described about local situation and modalities of work in his area, but who will do so is unclear because District Program officers are given charge of some specific programs and no one is there to provide holistic situation. To tackle this issue the Indian Public Health Standards(IPHS) report suggest recruitment of Public Health Manager at every CHC level which has not been implemented. It carries lot of advantage of carrying planning activites from district level to block level.

    The need is to enhance micro planning, setting liabilities, proper monitoring , sorting out local issues, charting realistic targets,empowering district administrators for manpower management.

    The problem which is more severe is lack of specialists, but still there are various places where speacialists are serving as District program officers rather than providing treatment care of the concerned speciality, is it not mismanagement of human resource?

    Moreover if govt. is having such a severe shortage of Doctors, then why the state do not think about working doctors who have to appear in the court post-poning some surgeries for just repeating in the court what they already have mentioned in their report or MLR. Many a times doctors reach the court on summon but judge goes on leave harassing the Doctor and the patient waiting for him in the hospital. In-service doctors would be more aware of such things. It is an important reason for many quitters from the civil medical services. Judicial rules regarding summoning the Doctors should be reviewed and ammended and judicials should understand the importance of Doctor’s time.

    The issue of utmost importance is that how long the health care delievery system will run as a subsidies? Is it possible to accomplish the motive of health for all by funding as subsidies? Should we not make the larger public sector hospitals self reliant by allowing their management to run parallel health facilities comparable to private sector ones at some decent charges? Should we not encourage invovement of Health professionals and management poeople in policy making rather only depending upon Administrative people learning from our failures in various programs? Although these issues require more debate and separate discussion.

    Some of the solutions emerging are as follows:

    1. The state must appoint Public Health Manager at CHC level preferably a MD community medicine decreasing the workload on the part of civil surgeons/CMOs.

    2. The state health directorate should have a full fledged HR department with specialized staff and dedicated budget.The states should develop short and long term human resource strategies and plan by adopting the standard process of manpower planning.

    3.The existing recruitment rules should be reviewed and modified in the light of changing job requirements and improvement in overall education level.

    4. Recruitment of programme staff should be undertaken with a view at long term utilization.

    5. The states should review the sanctioned post as per the existing workload and create additional posts wherever required.

    6. The government should either ensure that the recruitment process is completed in time by the recruiting agency or explore the possibility direct recruitment of technical staff by the department.

    7. There is a need for flexibility in fixing compensation for health personnel in order to make the government services more attractive. Further promotions should be linked to training and attainment of higher knowledge and skills relevant to service delivery.Why only a single rank of MO for around 16-20 years before promotion to SMO?

    8. The state governments should devise policy for providing financial incentives along with better housing and education facility for children to make rural posting more attractive.Why not their children can be provided education in Army schools?

    9. The state government should consider time bound promotion and transfer policy for all category of staff.Why not make it more transparent by setting detailed guidelines rather than lending decisions in hands of few officials?

    10. The state should undertake proper training of supervisory staff and effective monitoring of supervisory activities in order to strengthen supervision.

    11. The states needs to adopt a comprehensive training policy based on the actual needs as per the job requirement.

    DR. SUMEET SINGH, GMC Patiala

  4. […] Ranu Dhillon (which questions the role of community-based health insurance) and an introduction to India’s universal healthcare proposal by Anna Marriot of Oxfam. Some concerns have been raised that […]

  5. samantha says:

    The website which you have mentioned has a lot of valuable information in it which totally resembles about the given information !

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Global Health Check was created by Anna Marriott and is currently edited by Mohga Kamal-Yanni