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Daily-current-affairs / 27 Nov 2023

Navigating the Path to Universal Health Coverage : Daily News Analysis


Date : 28/11/2023

Relevance: GS Paper 2- Social Justice - Health

Keywords: Universal Health Coverage (UHC), Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) , Ayushman Bharat Digital Mission, COVID-19


  • The global pursuit of Universal Health Coverage (UHC) is facing multifaceted challenges, with nations striving to meet the Sustainable Development Goals (SDGs) set for 2030. The essence of UHC lies in ensuring that all individuals have access to high-quality health services without financial barriers.
  • In India, the Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) serves as a flagship initiative to achieve UHC. However, the world is grappling with off-track progress, exacerbated by the COVID-19 pandemic, manpower shortages, and widening gaps between rich and poor households.

Universal Health Coverage (UHC)

  • Universal Health Coverage (UHC) is the principle that ensures every individual has access to a complete range of high-quality health services, regardless of financial constraints. This encompasses all essential health services, spanning health promotion, preventive measures, treatment, rehabilitation, and palliative care.
  • UHC addresses primary, secondary, and tertiary care, making it accessible to all individuals at an affordable cost without discrimination based on financial status, gender, race, place of residence, ability to pay, or any other factors.
  • The slogan "Health for All by 2000," proposed by Halfdan Mahler in 1977 and endorsed by the World Health Assembly, inherently signifies universalization, emphasizing that healthcare should be available to everyone without denial or discrimination. UHC has evolved into a widely accepted goal in global public policy.
  • A universally acknowledged concept in health systems, established since the Beijing Health Systems Research Conference in 2012, is the idea of a multi-nodal system. This system comprises diverse sectors, professional streams, and specialties, employing a variety of staff to deliver Comprehensive Universal Health Care.

Current Scenario and Challenges

  • Global Struggle and Stagnation:
    Progress towards UHC, as outlined in SDG target 3.8, has faltered globally. Since 2015, improvements in health services coverage have stagnated, and the burden of out-of-pocket health spending has escalated continuously since 2000.
  • Manpower Shortages:
    Western and Central Asian nations are facing acute shortages of healthcare personnel, posing a significant challenge to the delivery of essential health services.
  • Pandemic Disruptions:
    The COVID-19 pandemic has disrupted essential health services in a majority of countries, underscoring the vulnerability of health systems to external shocks.
  • Economic Disparities:
    The gap between poor and non-poor households widens as sickness forces individuals to withdraw from employment, leading to increased financial strain and the depletion of productive assets.
  • Poverty and Health Spending:
    Catastrophic health expenditures push 55 million people into poverty annually, emphasizing the urgent need for comprehensive UHC measures.

Challenges in Implementing UHC in India:

Inequitable Health Insurance Access:

  • Lowest health insurance coverage is found among the economically disadvantaged,
  • indicating an inequitable access issue.
  • NFHS-5 results highlight a significant gap, with only 36.1% coverage in households with the lowest wealth quintile.

Financial Protection Gaps:

  • Despite schemes like Janani Shishu Suraksha Karyakram, high out-of-pocket expenses persist, particularly in urban areas. Disparities in expenditure and healthcare access exist among Indian states, with rising out-of-pocket costs in several regions.

Insurance Policy Errors:

  • Studies reveal inclusion and exclusion errors in health insurance policies, including the Pradhan Mantri Jan Arogya Yojana, leading to coverage issues for eligible and ineligible households.

Service Availability Concerns:

  • While 56% of PMJAY-empanelled hospitals are in the public sector, 40% are in the private for-profit sector, potentially concentrating services in specific areas. This indicates potential imbalances in service availability based on prior experience with publicly funded health insurance schemes.

Inadequate Infrastructure:

  • Insufficient infrastructure, including health facilities, equipment, and medical supplies, poses a major hurdle to achieving UHC. A 79.5% shortfall of specialists at Community Health Centers emphasizes the inadequacy in personnel.

Poor Health Education:

  • Lack of education and awareness on healthy lifestyles and preventive measures contribute to an increase in preventable illnesses and conditions.

India's Health Expenditure and Comparisons

  • Low Health Spending:
    India's current health expenditure, at about 3.2% of its GDP (Rs 8 lakh crore), falls significantly below the average health spending share of GDP in Lower and Middle-Income Countries (LMIC), which stands at around 5.2%.
  • Government Expenditure Disparities:
    The government's health expenditure in India, both at the central and state levels, is notably lower compared to countries like China, Thailand, Vietnam, and Sri Lanka.

Digital Health Initiatives

  • Global Initiative on Digital Health:
    India's leadership in digital health is highlighted through the Global Initiative on Digital Health launched under its G20 presidency. This initiative aims to attract investments into digital health and facilitate international collaboration.
  • Ayushman Bharat Digital Mission:
    India's indigenous digital health movement, the Ayushman Bharat Digital Mission, is gaining momentum. Digital health is viewed as a crucial tool for managing the complexities of UHC expansion, addressing challenges through effective contract administration and value-based reimbursement.
  • Role of Artificial Intelligence:
    AI is rapidly transforming healthcare worldwide, with India positioned to lead this revolution. In diagnostics, AI-powered tools enhance accuracy and efficiency, while predictive analytics and personalized treatments revolutionize healthcare procedures and drug discovery.

Spreading Digital Infrastructure and Lessons for Others

  • Need for Digital Infrastructure:
    India's journey in digital health serves as an example for other low- and middle-income countries seeking to expand UHC. The importance of widespread digital and data infrastructure is underscored.
  • Medical Brain Drain and 'Heal in India':
    Initiatives like 'Heal in India' and pervasive staff shortages in the West could exacerbate medical brain drain. Lessons from India's policies could guide other nations in addressing staff shortages.

Private Sector Participation

  • Beyond Public Sector Solutions:
    Acknowledging that the public sector alone cannot achieve UHC, the need for extensive private sector participation is emphasized. Expanding Publicly Financed Health Insurance (PFHI) entails integrating a significant portion of the private sector into the public healthcare framework.
  • Multilateral Collaboration:
    The complex nature of modern health challenges calls for multilateral and synergistic coalitions involving both public and private sectors. Collaborative efforts are crucial for comprehensive UHC.

WHO's Recommendations and Primary Health Care Approach

  • Reorienting Health Systems:
    The World Health Organization (WHO) recommends reorienting health systems using a Primary Health Care (PHC) approach. Emphasizing that 90% of essential UHC interventions can be delivered through PHC, potentially saving lives and increasing life expectancy globally.

The Way Ahead

  • Balancing National and International Goals:
    It is imperative to ensure that national interests align with international ambitions in achieving UHC. Leveraging digital technologies to create non-competing solutions mindful of the Global South is crucial.
  • Incremental Reforms and Best Practices:
    Countries are urged to build on existing systems, implementing reforms and best practices incrementally to strengthen their healthcare systems.
  • Commitment to Excellence:
    The way ahead requires concerted efforts and a commitment to excellence. With sustained dedication, a healthier and more prosperous India can be built, ensuring well-being for generations to come.
  • Health Financing:
    In order to achieve UHC, it is vital that governments intervene in their country’s health financing system to support the poor and vulnerable.
    • This requires establishing compulsory publicly governed health financing systems with a strong role for the state in raising funds fairly, pooling resources and purchasing services to meet population needs.
    • Greater targeted financing for public health systems will help tackle inherent weaknesses around quality of care and access, reduce out of pocket spending on drugs and improve human resource and infrastructure shortfalls.

Steps Taken by Government for UHC

  • The National Health Policy (NHP) 2017 advocated allocating resources of up to two-thirds or more to primary care as it enunciated the goal of achieving “the highest possible level of good health and well-being, through a preventive and promotive healthcare orientation”.
  • A 167% increase in allocation this year for the Pradhan Mantri Jan Arogya Yojana (PMJAY) — the insurance programme which aims to cover 10 crore poor families for hospitalisation expenses of up to ₹5 lakh per family per annum.
  • The government’s recent steps to incentivise the private sector to open hospitals in Tier II and Tier III cities.
  • Individual states are adopting technology to support health-insurance schemes. For instance, Remedinet Technology (India’s first completely electronic cashless health insurance claims processing network) has been signed on as the technology partner for the Karnataka Government’s recently announced cashless health insurance schemes.


In conclusion, the journey towards Universal Health Coverage demands a comprehensive and collaborative approach, leveraging digital technologies, private sector engagement, and global cooperation. The challenges are formidable, but with strategic planning and shared commitment, nations can pave the way for a healthier future.

Probable Questions for UPSC mains Exam-

  1. How can the integration of digital health initiatives, such as the Ayushman Bharat Digital Mission, contribute to overcoming challenges in achieving Universal Health Coverage (UHC) in India and other developing nations? (10 Marks,150 Words)
  2. In light of the disparities in health expenditure and the role of the private sector in UHC, how can governments strike a balance between public and private sector participation to ensure equitable access to high-quality healthcare for all citizens? (15 Marks,250 Words)

Source- Indian Express/ Sansad TV