HomeAboutusEditorial BoardCurrent issuearchivesSearch articlesInstructions for authorsSubscription detailsAdvertise

  Login  | Users online: 473

   Ahead of print articles    Bookmark this page Print this page Email this page Small font sizeDefault font size Increase font size  


 
 Table of Contents    
EDITORIAL - COMMENTARY  
Year : 2020  |  Volume : 45  |  Issue : 1  |  Page : 1-2
 

Achieving Universal Health Coverage in India: The Need for Multisectoral Public Health Action


Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India

Date of Submission05-Feb-2019
Date of Acceptance16-Sep-2019
Date of Web Publication14-Jan-2020

Correspondence Address:
Dr. Rajesh Kumar
Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh - 160 012
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijcm.IJCM_61_19

Rights and Permissions

 



How to cite this article:
Kumar R. Achieving Universal Health Coverage in India: The Need for Multisectoral Public Health Action. Indian J Community Med 2020;45:1-2

How to cite this URL:
Kumar R. Achieving Universal Health Coverage in India: The Need for Multisectoral Public Health Action. Indian J Community Med [serial online] 2020 [cited 2020 Jul 6];45:1-2. Available from: http://www.ijcm.org.in/text.asp?2020/45/1/1/275971




Health indicators have been gradually improving in India, but health for all is yet to be achieved. The life expectancy is 68.7 years, infant mortality rate is 33/1000 live births, maternal mortality ratio is 130/100,000 live births, and total fertility rate is 2.3 children/woman; however, large inequities by geography, gender, class, caste, religion, and region are seen.[1] Health of the Nation's States Report[2] indicates that despite rising income, poverty and hidden hunger still exist; environmental pollution has increased, more so, in urban areas; sanitation services and clean fuel use have not yet improved to the desired level, especially in the villages. In urban areas, slums have mushroomed, built area has increased, and open spaces have shrunk. Moreover, dietary patterns have changed in favor of more sugar, salt, fat, and alcohol, whereas consumption of vegetables and fruits has declined. Mechanization, especially motorized transport, has encouraged sedentary life styles and a rise in road traffic injuries is noticed. The gap between aspirations and real-life situations has pushed many into addictions and mental health problems. To address these issues, multisectoral public health actions are needed, in addition to the reorientation of health sector.

In the last decade, the implementation of the National Health Mission (NHM) did bring back some focus on social determinants of health and encouraged development of a health system based on primary health care.[3] Investments in health system led to improvement in health services. It had an impact on health indicators, but the full potential of NHM is yet to be realized.[4] The recently announced Ayushman Bharat Mission (ABM) has started insurance coverage for selected package of medical and surgical procedures for hospitalized patients belonging to socioeconomically vulnerable families on the lines of Rashtriya Swasthya Bima Yojna though the insurance amount is larger.[5] The development of subcenters into health and wellness centers continues to be under the NHM. These two missions, i.e., NHM and ABM, deal with primary and secondary care, respectively. In the absence of a linkage between these two missions, it may not be possible to maintain a balance. Therefore, the funds earmarked for ABM should flow through the primary health-care system on per capita basis. The primary health-care providers should be empowered to decide which patient to refer, to which hospital (public or private), and at what cost to pay, so that ultimately health services are cashless for the patient. Coordinated actions are required not only within the health and family welfare ministry, but across multiple sectors. Hence, to operationalize multisectoral public health action in a decentralized manner, every village or urban ward should have Arogya Kendra (health center) financed by the state through a village or ward fund, but managed by local volunteers under the guidance of the community it serves, and it should have a decentralized Integrated Health Information System for Universal Health Care supported by Information Communication Technology (ICT), if possible.

Devolution of funds to district health societies and decentralization of planning, implementation, and monitoring would build a sustainable system rooted in local sociocultural contexts, which will be able to harness the locally available resources. However, broad policy framework, guidelines, and oversight can remain at the central and state level. Primary health-care teams should be incentivized to invest in prevention and health promotion, so that health literacy improves and spending on illness care can be reduced. Therefore, NHM and ABM should advocate for a comprehensive public health-oriented “whole-of-government” intersectoral health promotion initiative keeping in view “inclusive growth” and “health development” as a social goal of the society. Health impact assessment of all public policies should be mandated by legislation. “Prevention of diseases” is a more cost-effective strategy than the popular approach of “Treatment.”

Therefore, several countries have reengineered their health systems in a variety of ways to protect and improve peoples' health. For example, in England, the Health and Social Care Act 2012 reorganized the health services to create National Health Service England and Public Health England,[6] and in Thailand, the National Health Security Act 2002 granted everyone the right to a standard and efficient health service and established National Health Security Office to improve universal health coverage.[7] The World Health Organization has also recently planned a call to countries to set up leadership at all levels to protect the people from public health emergencies, to improve universal health coverage, and to ensure that people enjoy better health and well-being.[8]

Indian should also reorganize its health system. Parliament should promulgate Indian Public Health Act with a mandate to protect and promote health of people as a fundamental right to health and health care. An autonomous “Public Health Commission” should be established to implement the provisions of the Act. It should have a public health commissioner with three deputy commissioners to head (a) epidemiology, (b) public policy, and (c) health promotion and education divisions. At state level, an additional public health commissioner should chair the State Public Health Commission which should have three deputy commissioners representing the above-mentioned three divisions, and at district level, a public health officer should head the District Public Health Commission who should be assisted by three additional public health officers. Each municipality should have a deputy public health officer and three public health supervisors. The Panchayat Raj Institutions, at district and community development block level, should have a deputy public health officer and an assistant public health officer. At Panchayat level, a public health supervisor should be appointed. Public Health Commission should have sufficient infrastructure (secretarial support staff, technical staff, equipment, office space, and budget) so that, in coordination with all sectors, a Public Health Action Plan can be prepared, funded, implemented, and monitored periodically.

In summary, to achieve the universal health coverage, major challenge in India is promotion of health, prevention of diseases, and provision of health care in a balanced manner, which will require innovative public policies, strategies, and programs in many sectors. Development and implementation of a multisectoral approach to achieve sustainable development goals is the need of the hour. Establishment of a Public Health Commission will go a long way in achieving coordination of various initiatives not only in the Ministry of Health and Family Welfare but also in many other relevant ministries/sectors. At least 5% of the gross domestic product should be earmarked for public health and a responsive governance mechanism as outlined above should be set up, to achieve universal health coverage by 2030 as envisaged in the United Nations sustainable development goals which are also endorsed by the Government of India.[9]



 
   References Top

1.
Office of Registrar General of India, Government of India. Sample Registration System. New Delhi: Office of Registrar General of India, Government of India. Available from: http://censusindia.gov.in/2011-Common/Sample_Registration_System.html. [Last accessed on 2019 Apr 20].  Back to cited text no. 1
    
2.
Indian Council of Medical Research, Public Health Foundation of India, and Institute for Health Metrics and Evaluation. India: Health of the Nation's States – The India State-Level Disease Burden Initiative. New Delhi, India: Indian Council of Medical Research, Public Health Foundation of India, and Institute for Health Metrics and Evaluation; 2017. Available from: http://www.healthdata.org/sites/default/files/files/2017_India_State-Level_Disease_Burden_Initiative_-_Full_Report%5B1%5D.pdf. [Last accessed on 2019 Apr 20].  Back to cited text no. 2
    
3.
National Health Mission. Ministry of Health and Family Welfare, Government of India, New Delhi. Available from: http://nhm.gov.in/. [Last accessed on 2019 Apr 20].  Back to cited text no. 3
    
4.
Gupta M, Angeli F, Bosma H, Prinja S, Kaur M, van Schayck OCP, et al. Utilization of intergovernmental funds to implement maternal and child health plans of a multi-strategy community intervention in Haryana, North India: A retrospective assessment. Pharmacoecon Open 2017;1:265-78.  Back to cited text no. 4
    
5.
Bharat A. Ministry of Health and Family Welfare, Government of India, New Delhi. Available from: https://www.india.gov.in/spotlight/ayushman-bharat-national-health-protection-mission. [Last accessed on 2019 Apr 20].  Back to cited text no. 5
    
6.
The Health and Social Care Act. Government of United Kingdom, London: The Health and Social Care Act; 2012. Available from: http://www.legislation.gov.uk/ukpga/2012/7/pdfs/ukpga_20120007_en.pdf. [Last accessed on 2019 Apr 20].  Back to cited text no. 6
    
7.
National Health Security Act B.E. 2545 (A.D.2002). Bangkok: National Health Security Office, Royal Thai Government. Available from: https://www.nhso.go.th/eng/files/userfiles/file/2018/001/NHS%20ACT_book_revised%20Apr5.pdf [Last accessed on 2019 Apr 20].  Back to cited text no. 7
    
8.
World Health Organization. Draft Thirteenth General Programme of Work, 2019-2023. World Health Organization; 05 April, 2018. Available from: http://apps.who.int/gb/ebwha/pdf_files/WHA71/A71_4-en.pdf?ua=1. [Last accessed on 2019 Apr 20].  Back to cited text no. 8
    
9.
Sustainable Development Goals. United Nations, New York. Available from: https://sustainabledevelopment.un.org/?menu=1300. [Last accessed on 2019 Apr 20].  Back to cited text no. 9
    




 

Top
Print this article  Email this article
           

    

 
   Search
 
  
    Similar in PUBMED
    Search Pubmed for
    Search in Google Scholar for
    Article in PDF (288 KB)
    Citation Manager
    Access Statistics
    Reader Comments
    Email Alert *
    Add to My List *
* Registration required (free)  


    References

 Article Access Statistics
    Viewed640    
    Printed30    
    Emailed0    
    PDF Downloaded324    
    Comments [Add]    

Recommend this journal

  Sitemap | What's New | Feedback | Copyright and Disclaimer
  2007 - Indian Journal of Community Medicine | Published by Wolters Kluwer - Medknow
  Online since 15th September, 2007