December12 is commemorated as Universal Health Coverage Day, globally. The Universal Health Coverage (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?.
Though, not entirely a new concept, the Universal Health Coverage (UHC) received global attention as an idea and aspiration with the World Health Assembly 2005 resolution, urging member states to develop their health financing systems for transitioning to UHC. This was further reinforced by the United Nations General Assembly 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 (who are the attendees at World Health Assembly) to the heads of state and ministers of foreign affairs (who are the attendee at UNGA). To commemorate UNGA resolution on UHC, this day is now globally commemorated as UHC day. Understandably, the UHC has found a place in Sustainable Development Goals (SDGs) agenda as wellhealth goal 3 (or SDG-3). A specific target in SDG-3 on UHC is often considered overarching for all other targets in health goal.
There is a long journey towards UHC in most low and middle income countries. Let?s take example of India. A few months ago, reputed medical journal The Lancet reported that in terms of healthcare services Index, India was ranked at 154 out of 195 countries. In India, the accessibility to services is limited due to multitude of reasons: geographical, financial and cultural barriers, to list a few. The quality of health services delivered is unknown or poor. Unqualified people providing services are common challenges. People are overcharged when accessing services. The government has acknowledged in new national health policy that every year 6.3 Crore people fall into poverty due to health related expenditure. Those who were already below poverty line fall deeper into poverty. Health related expenditure are partially undoing governments interventions to alleviate poverty. Clearly, India is not doing very well on health services and it earnestly need to take steps to move towards UHC.
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 (who would approve any policy and plan on UHC) and common man/woman(as to what it would mean for their family and themselves and to demand for it).
Let?s take example of a poor, old, widow living in a tribal village of India. To her, UHC would mean that she wouldhave access to desired health serviceswithin acceptable distance and time frame. Her decision to seek healthcare services and choice to select a health facility would not depend upon health problem, place of living, or income level. She would have enough choice on providers and when she would need specialized care, it would be facilitated by first level of providers. When attending the health services from licensed providers, she would not have to worry about the quality. She would have reasonable assurance that government would have mechanisms in place that she receives good quality services. Shewouldhave 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 Immunization 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 select number of vaccines (though, there are many more available in private market) to all children in the country. The additional vaccines are available in private sector on payment basis. The vaccines in UIP are delivered through designated health facilities and 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 private sector. Majority of parents prefer government facilities for vaccination; however, a few choose private sector. If they attend government facilities vaccines are free; however, they have to pay for these vaccines, and also for vaccines which are not part of the government program, if they choose to get their child vaccinated at private facility. There is no evidence or indication that any family has ever got poor due tovaccination services.
However, UHC should not be confused with single programme or scheme and we don’t mean to achieve UHC for immunization or UHC for tuberculosis. It is a holistic concept for agreed minimum essential package for large enough segment of population in incremental fashion to reach entire population in a time-bound system.
India has been at the forefront of policy discourse and has done some background work and seems to be ready to take a giant leap towards UHC. The National Health Policy of India (2017) has possibly the most explicit ?statement of intent? to advance UHC in the country. The Union and state governments in India are considering mechanisms to ensure that people do not become poor while accessing health services. However, the Indian governments are not known for translating policy into actions. Achieving UHC would need more rapid ?policy to implementation? transition. 12 Dec, the UHC day, provides that opportunity. What we do collectively today and in the time ahead, will determine the health status and health seeking behavior 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 country can consider to have achieved Universal Health Coverage.
