The challenge of universal health coverage

Context: The ongoing national conversation on what India needs
to do for universal health coverage (UHC) often misses the complexity of
multiple health systems and the unique challenges they bring. Every health
system type that is seen globally is present in different parts of India. Government
expenditure (per capita) on healthcare, for example, varies significantly from
State to State. Himachal Pradesh, Kerala, and Tamil Nadu spend ₹3,829, ₹2,590,
and ₹2,039, respectively, while Uttar Pradesh and Bihar spend only ₹951 and
₹701, respectively. West Bengal, a rural State, has a low fertility rate at
1.64, but it also has one of the highest teenage pregnancy rates (16%). This is
hugely different from other States with low fertility, such as Kerala and
Himachal Pradesh, where teenage pregnancy rates are 2.4% and 3.4%, respectively.

Key points

·      
Overview: The expansion of Universal health coverage will be
complex, but data and digital technology can smoothen the way.

·      
Universal
Health Coverage (UHC): 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. It covers the full continuum of essential health services,
from health promotion to prevention, treatment, rehabilitation, and palliative
care across the life course.

SDG
target - Achieving UHC is one of the
targets the nations of the world set when they adopted the 2030 Sustainable
Development Goals (SDGs) in 2015.

·      
UHC in
India: Currently, India aims to
attain UHC through the expansion of the Ayushman Bharat-Pradhan Mantri Jan
Arogya Yojana (AB-PMJAY), the flagship publicly financed health insurance
(PFHI) scheme of the Union government.

·      
Challenges: Off-track progress - The world is off track to
make significant progress towards universal health coverage (Sustainable
Development Goals (SDGs) target 3.8) by 2030.

Shortage
of manpower - Many Western and Central
Asian nations today are staring at acute shortages of manpower in healthcare.

Disruption
due to pandemic - The
COVID-19 pandemic further disrupted essential services in 92% of countries at
the height of the pandemic in 2021. In 2022, 84% of countries still reported
disruptions.

·      
Suggestions
for improvement: Global
Initiative on Digital Health - It is here that India’s leadership in
digital health becomes significant. Under India’s G20 presidency, the WHO has
launched a Global Initiative on Digital Health aiming to marshal investments
into digital health and facilitate regional and international exchange and
reporting on health.

Role
of India’s Digital Health journey - India’s own indigenous digital health movement, the Ayushman Bharat
Digital Mission, preceded this initiative and is steadily gathering steam. Digital
health must be seen as a tool for effectively managing the inevitably complex
nature of UHC expansion.

·      
Role of AI: Artificial Intelligence (AI) is rapidly transforming
health care worldwide, and India has the potential to be at the forefront of
this revolution.

Diagnostics
- One of the key areas where AI can
make a significant impact is in diagnostics.

Predictions
& preventions -
Additionally, AI can help predict disease outbreaks, analyse health-care data,
and optimise treatment plans, expediting health-care procedures, and
revolutionising drug discovery ultimately making health care more personalised
and effective.

·      
Way Ahead: It will be imperative that national interests don’t
lose ground to international ambitions and that digital technologies are
leveraged to create non-competing solutions that are mindful of the Global
South. Countries need to build on their existing systems, overlaying reforms,
and best practices incrementally.