A humane society must have universal health coverage. This is a laudable aim in itself; it is even more significant in the Indian context.
With profound health challenges and almost 30% of its population living below the poverty line, India must confront the challenge of keeping its citizens healthy. Simply put, providing and financing universal health coverage (UHC) for 1.2 billion people can be a challenging proposition, and the government needs all the help that it can get.
India has made impressive economic gains in the post-liberalisation period.
Juxtaposed against this, inequity too has grown and this is evident in levels of access to healthcare. The uptake of health services has remained low among people at the bottom of the economic pyramid, and even the rapidly expanding lower-middle class remains susceptible to slipping back into poverty in the face of a health crisis. This is because in India 70% of health costs are paid for out-of-pocket at the point of service, with expenditure ranging from zero to more than Rs 10 lakh.
Universal health coverage would, therefore, not only ensure that Indian citizens stay healthy; it would also protect them from being driven or trapped below the poverty line by illness.
Many of India’s fundamental health indicators are dismal compared even to poorer neighbours. India’s immunisation rates are abysmally low: Only 70% of children receive even the basic vaccines today. These levels have persisted since 1990, while a lower-income country such as Bangladesh has driven significant improvement in this indicator and achieved a 95% immunisation rate.
Globally, the field of health is witnessing a shift in focus from disease-driven initiatives to projects aimed at increasing the sustainability and strengthening of health systems. A crucial component of achieving this will be to secure sustainable financing for health services.
On its part, the government has focused a large portion of its resources on primary and secondary healthcare services, while also devoting a sizeable share to tertiary services. Although urban India has better health infrastructure, the private sector is the dominant provider and costs are higher.
Innovative partnerships could certainly help address this complex set of challenges.
The private sector can help finance the capital costs involved in setting up new healthcare facilities as well as provide management and technical expertise in delivering health services at scale. It can also help train the government’s frontline health workers in the aspects of health service delivery.
The National Health Mission has adopted participatory models to fill vacancies in public healthcare facilities by contracting private practitioners.
Gujarat, Rajasthan, Uttarakhand and Karnataka have also been working with private healthcare providers to deliver essential diagnostic, telemedicine, telehealth and mobile health clinic services. The government can make investing in rural areas both profitable and sustainable for private healthcare providers.
India should leverage all available resources to improve its health services. Given the diversity across states, it should avoid embracing one-size-fits-all models and allow enough flexibility for local design experimentation within an overarching national UHC plan.
Sangita Reddy is joint managing director of Apollo Hospitals Enterprise Limited. The views expressed are personal.