Year : 2012 | Volume
: 37 | Issue : 2 | Page : 69--70
Universal access to health care for all: Exploring road map
National Programme Officer (RH) UNFPA, EP-16/17, Chandragupta Marg Chanakyapuri, New Delhi, India
National Programme Officer (RH) UNFPA, EP-16/17, Chandragupta Marg Chanakyapuri, New Delhi
|How to cite this article:|
Agarwal D. Universal access to health care for all: Exploring road map.Indian J Community Med 2012;37:69-70
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Agarwal D. Universal access to health care for all: Exploring road map. Indian J Community Med [serial online] 2012 [cited 2013 May 25 ];37:69-70
Available from: http://www.ijcm.org.in/text.asp?2012/37/2/69/96081
As we slip into the XII th Five Year in April 2012 in background of Govt. of India commitment of 2.5 percent GDP public spending in health, there is a great degree of interest as to how universal access to health care is going to unfold during the plan period. Several opinions and perspectives are being articulated in public domain starting from Lancet series in 2010, high-level expert group report of Planning Commission, XII th Five Year Plan approach paper as well as discussions in public health activists' forums. Public health professionals are deeply engaged in the intense debate about nature, magnitude and direction of much needed reforms in health care in India.
Universal access to health care implies that everyone gets equitable access to health care and there is no discrimination especially on capacity to pay. This would clearly mean public financing of health care with no out of pocket expenditures at point of care. Given that health is a state subject and nearly three-fourth public spending is from state governments' resources (despite NRHM resources), issue is of how a single payer for health care would organize and function. In addition the single payer (either at district or state level) would also collect premium through pay role deduction for organized sector or from RSBY. Private health insurance has been witness to impressive growth in last few years and there has to be more clarity on role of this sector going forward. Needless to say, there has to be a well thought out strategy for pooling all resources deployed in health sector. Package of services to be offered at different levels would also dictate financing mechanisms. Unfortunately, discussion so far does not throw much light on what would go in primary health care (which should be fully funded by the state) to secondary and tertiary health care (especially catastrophic illnesses).
Another dimension of universal access to health care relates with provisioning of health care. One cannot ignore vast private sector (qualified, unqualified, less than qualified etc.) in provisioning of health care. There is general view that private health sector needs to be engaged in provisioning. However, given the heterogeneous and fragmented private sector often with dubious quality there is mammoth task at hand. Private sector has so far thrived in absence of little or no regulation and rampant irrational therapies and supply induced demand. The National Health Service of UK appears to be one example in which private providers play a highly significant role in delivery of primary health care with emphasis on prevention and promotive interventions. Should there be "contracting in" or "out"?? Experience from the range of public-private partnerships in NRHM is not encouraging be it in contracting in to run facilities or contracting out such as for FP sterilization. There are two divergent set of opinions. While one option aim towards initiating policy reforms for progressive socialization of private sector another opinion largely argue for greater, deeper and seamless engagement with private sector. Processes would also be guided with human resources in health sector policy paradigms, technological options to be pursued.
Much would depend on how governance issues are handled. NRHM started with the premise of making "architectural corrections" in delivery of health care especially in rural areas. Except for a vast cadre of contractual personnel in supporting programme management (SPMUs, DPMUs and BPMUs, consultants supported by NRHM or development partners), where are the systemic changes? Reviews after reviews have highlighted as how NRHM is seen as a vertical programme funded by GOI to be implemented by consultants. Regular programme management staff is either insulated from NRHM or is simply not ready to share "additional burden". NRHM implementation framework makes a strong plea for greater community engagement and ownership. Lack of conceptual clarity in defining village health plan, block health plans and district health plans have defeated the concept of decentralized and people centric and responsive health care. Going forward, it is important to ensure that governance system in human resources, convergence/integration of different programmes capacity building and assessment and evaluations are well thought out and are able to deliver promise of UAHC. Given the current state of district health organizational arrangements as well as huge responsibilities going to be entrusted to them in terms of accreditation etc., mere tinkering is not enough. A major revamp is need of hour. Good governance requires a high degree of transparency and accountability in public and organization processes.
Reorganization, restructuring and regulation will be integral components of a big ticket health sector; reforms being contemplated in UAHC. Right moves would reduce health care spending by half and reduce burden of seeking health care for households. Recent reports on high magnitude of malnutrition, continued burden of communicable diseases and emerging challenges of NCDs paints grim picture. The roadmap for UAHC has to be detailed out so that we do not falter once again. As public health professionals, we owe a responsibility to our nation by being an active partner in addressing challenges in the delivery of health care.