By Ali Mehdi

December 12 is Universal Health Coverage (UHC) Day. According to World Health Organization (WHO), 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” (bit.ly/3ZkKMJC).

Quality, defined as “the degree to which health services for individuals and populations increase the likelihood of desired health outcomes”, is a core dimension of UHC. “Access without quality can be considered an empty universal health coverage promise” since “even if the world achieved essential health coverage and financial protection, health outcomes would still be poor if services were low-quality and unsafe”, argues a WHO, OECD, and World Bank report (bit.ly/3OFZJ4c).

India’s journey towards UHC started around Britain’s social security reforms. William Beveridge, born in India in 1879, presented a report on Social Insurance and Allied Services to the British government in 1942, which became the basis for its National Health Service (NHS) Act of 1946. In India, BP Adarkar, who Sardar Vallabhbhai Patel referred to as ‘Chhota Beveridge’, was appointed in 1943 to develop a plan for industrial workers. Beveridge was also approached for the same, but refused—he felt the focus should be on ‘the greater part of the Indian population’ and not industrial workers alone (bit.ly/4ipgrT5).

Adarkar presented an integrated plan of health, maternity and employment injuries insurance to the Indian government on August 15, 1944, which became the basis for the Employees’ State Insurance (ESI) Act of 1948. It offered multidimensional social security for industrial workers. The ESI Scheme (ESIS) was inaugurated on February 24, 1952. Two years later came the Central Government Health Scheme (CGHS), followed by the Ex-Servicemen Contributory Health Scheme (ECHS) in 2003, the National Rural Health Mission (NRHM) in 2005, Rashtriya Swasthya Bima Yojana (RSBY) in 2008, and Ayushman Bharat in 2018.

How has India done in its 70-year journey (1948-2018) towards UHC? 

1) During 2019-21, only 41% Indian households had a usual member covered by a health insurance / financing scheme, ranging from 1.8% in Andaman & Nicobar Islands to 87.8% in Rajasthan (National Family Health Survey [NFHS] 2019-21). 

2) Half of Indian households do not generally use a government health facility—48% of them due to poor quality of care. The latter figure varies from 17% in Mizoram to 62% in Bihar (NFHS).

3) 60% of Indian women had at least one problem in accessing health care when sick (NFHS).

4) 32% of Indian women (15-49 years) had contact with a government health worker over the past three months. This figure ranged from 11% in Chandigarh to 54% in Karnataka (NFHS).

5) 49% of the households that sought OPD care and / or hospitalisation faced catastrophic health expenditure (HE) and 15% fell below the poverty line due to out-of-pocket HE. HE pushes 32-39 million Indians below the poverty line every year (bit.ly/3ZzSpx7).

The situation is equally worrisome as far as the quality of health services is concerned vis-à-vis ‘desired health outcomes’.

1) India’s total fertility rate (TFR) declined from 5.7 to 2.0 during 1950-2023 (World Population Prospects: The 2024 Revision / WPP). It ranged from 1.1 in Sikkim to 3.0 in Bihar (NFHS).

2) India’s infant mortality rate (IMR) came down from 176 to 23 during 1950-2023, but it was still the world’s largest contributor to infant deaths in 2023 (5.25 lakh) (WPP). IMR, according to the NFHS, was 35 in India during 2019-21 and ranged from 3 in Puducherry to 50 in Uttar Pradesh.

3) India’s healthy life expectancy (HALE) went up by 9 years over a period of 29 years (1990-2019), coming down by 2 years over the two Covid-19 years. Its HALE was 61 years in 2019, with a variation of 10 years between its states (67 years in Goa and 57 

in Uttar Pradesh).

UHC is based on the core principles of quality and equality. India’s UHC policy should focus on the reduction of inequalities in core health outcomes. The TFR target should be 2.1 (replacement level fertility), while the IMR target should be zero for all states and socioeconomic groups. Inequality should be measured and policy priority assigned vis-à-vis the distance from these. As far as HALE is concerned, we should aspire for the highest in the world—76 years in Singapore—as well as the reduction of inter-state and inter-group differentials to ensure aggregate as well as distributive growth. If our economic aspiration is to be the world’s third largest economy, our social aspiration should be to be the healthiest country.

The author is Ali Mehdi, Founder and CEO, UHC360

Disclaimer: Views expressed are personal and do not reflect the official position or policy of FinancialExpress.com. Reproducing this content without permission is prohibited.