by Ranabir Bhattacharyya
India being a promising third world economy, continues to struggle to manage the ‘double burden’ of diseases. Universal Health Coverage from Indian context is indeed a tricky subject. Recently, National Health Policy of 2017 have been coupled to create a new initiative in the Union budget of 2018. National Health Policy had prioritized primary healthcare as the principal component of health system strengthening and proposed that 70% of the health expenditure would be directed there. Already, from NRHM implementation, some major gains in maternal and child healthcare were seen though all MDG targets were not met. Though accessibility and affordability issues continue to challenge, some success is achieved. National Health Policy 2017 and National Health Mission implementation in both rural and urban areas is a move forward. Recent announcement of Ayushman Bharat National Health Protection Mission - ‘Modicare’ , which is a parallel to Obamacare of America is highly ambitious but if implemented well is the need of the hour. Sustainable UHC model through social safety net and social health insurance is under way. However, quality, coordination, government infrastructure strengthening, skilled manpower at all levels, and supportive supervision/accountability issues need to be addressed urgently on a priority basis.
Interestingly, National Health Policy 2017 has given impetus to urban health issues such as urban poor, migrant population, and other vulnerable groups. Implementation of National Health Mission including rural and urban population is a step towards it. Mobilizing and establishing systems (funds, infrastructure and man power etc.) for urban health has begun but in the formalization phase. NRHM focus on maternal and child health showed positive impact, now the epidemiological shifts and NCD disease burden in rural areas have to be addressed. Urban people have better access to hospitals and care - even though expensive, access for rural population is still low.
At present, right from the policy and decision making level of the government, India is moving ahead with strategic steps . According to Dr. Usha Manjunath, Director IIHMR, ”India has a long way to go to fulfill the demands of Universal Health Coverage. Meanwhile, there have been so many encouraging steps undertaken. PPP and CSR model of care delivery to support existing systems in near future would also be a positive step towards UHC. Emergency and ambulance services in the last 10 years have improved significantly across the states, sustaining and continuous improvements are key to improve access and urgent care. No doubt, Mobile health clinics should be further extended to remote and inaccessible geographies for realizing UHC.
And, it is a fact that coverage for curative services, chronic care, mental health, and palliative care given the nation’s epidemiological spectrum is too vast to ramp up UHC in a short span of time. In terminal illnesses from cancer and other NCDs, treatment is very expensive. Such illnesses drain the pockets of even middle-class people and poor obviously have very limited resources as well as access. Palliative care policy and implementation has just begun in India and can definitely improve the scenario in the long run.” Mr Nageswaran C K , Facility Director , Fortis Malar Hospital, Chennai feels, “Healthcare is not affordable in India. India desperately needs a holistic care system that is universally accessible, affordable and at the same time effectively reduces OoP (Out-of- pocket) expenditure.”
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