Exploring the history of universal healthcare in India through policies

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Definition

Universal Health Coverage (UHC) means guaranteeing equitable health access to all Indian citizens, including promotive, preventative, curative, and rehabilitative health services with the government being the guarantor and enabler, although not necessarily the only provider of health and related services (Source: National Health Portal). The idea behind UHC is that that every individual should be able to obtain the required health services without suffering financial hardship in paying for them.

History of UHC in India

The National Rural Health Mission (NHRM), launched in 2005, sought to provide accessible, affordable and quality health care to the rural population, especially the most vulnerable. Data on health outcome achievements for the Eleventh Plan period (2007-12) suggests that despite significant progress of the NRHM, three key challenges emerged. First, the quantum of healthcare services provided by the public and private sectors combined remained inadequate. Second, there was considerable inconsistency in the quality of services offered in both the sectors. Third, affordability remained a major burden for the vast majority of the rural population, especially regarding tertiary services. Now, the NRHM and the National Urban Health Mission (NUHM) have been subsumed under the National Health Mission (NHM). The 12th Five Year Plan along with the NHM’s Framework for Implementation committed to undertake up to three UHC pilots in each state, so as to scale up Universal Health Coverage across the country.

The 12th Five Year Plan envisaged comprehensive health security for all by making it obligatory on the part of the State to provide adequate food, appropriate medical care, safe drinking water, proper sanitation, education and health-related information for good health. In October 2010, the Planning Commission also constituted a High-Level Expert Group (HLEG) on Universal Health Coverage (UHC) with the objective of providing financial protection. However, it was recognised that the delivery of UHC and provision of quality care to every citizen also required the availability of adequate healthcare infrastructure, skilled health workforce, and access to affordable drugs and technologies.

Challenges

The total expenditure (public and private together) on health in India, including public and private expenditure, is broadly comparable to other developing countries, at 3.7 per cent of the GDP. However, public expenditure on health in India stands at 1.4% of GDP as compared to the global average of 5.4 per cent. In the absence of adequately funded public health services, there is high incidence of out-of-pocket expenditure by households on purchasing services from the private sector. According to World Bank data, out-of-pocket health expenditure (as a percentage of total expenditure on health) is around 62% (Source: World Health Organization Global Health Expenditure database). Moreover, 63 million people are pushed to poverty every year as they are unable to cover their healthcare costs, according to the Draft National Health Policy, 2015.

National Health Policy 2017 (Ministry of Health and Family Welfare, Government of India)

The National Health Policy 2017, which was cleared by the Centre in March. It aims to increase government’s health spending, progressively and timely, to 2.5% of the GDP. The policy document mentions the objective of “progressively achieving Universal Health Coverage.” It covers: i) the assurance of free, comprehensive primary health services to all; (ii) ensuring improved access and affordability of secondary and tertiary services; iii) achieving a significant reduction in out-of-pocket expenditure by households and consequent impoverishment due to rising health costs.

Basically, the Policy envisages guaranteeing healthcare to all Indian citizens, particularly the underprivileged sections, by strengthening the public health system and leveraging strategic public-private partnerships and non-profit support for (ii). However, the National Health Policy does not cover the aspect of making Right to Health a fundamental right in India.

‘Right to Health’ as a fundamental right in India

Right to Health is internationally recognised as a fundamental human right. India, too, is a signatory of the International Covenant on Economic, Social and Cultural Rights and The Universal Declaration of Human Rights.

In India, the Directive Principle of State Policy, under the Article 47, makes improvement of public health a primary duty of State. However, these directives are non-justifiable, meaning that no person can claim for non-fulfilling these directives. The Constitution of India guarantees some fundamental rights having a bearing on health care under the preview of Article 21: “No person shall be deprived of his life or personal liberty except according to procedure established by law.

Recently, a Private Member Bill was proposed in the Rajya Sabha by YSP Congress MP Vijaysai Reddy to make Right to Health a fundamental right in India. For this purpose, the scope of Article 21 will have to be expanded by implementing a constitutional amendment and introducing Article 21B. The bill, however, was not passed, landing the same fate as most private member bills in India. Since independence, only 14 such bills have received the consent of both houses and become a law with the last one being in 1970.

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