Moving forward with a newer concept of UHC – Understanding the Universal Health Care/coverage (UHC) | 20th March 2023 | UPSC Daily Editorial Analysis

What is meant by Health?

• As per the World Health Organization (WHO), “health is a certain totality of health to the realms of mental and social well-being and happiness beyond physical fitness, and an absence of disease and disability”.
• The determinants of health include:
  • the social and economic environment,
  • the physical environment, and
  • the person’s individual characteristics and behaviours.
• This means that we cannot achieve health in its wider definition without addressing health determinants.
• This necessitates a need for an intersectoral convergence beyond medical and health departments such as women and child development, food and nutrition, agriculture and animal husbandry, civil supplies, rural water supply and sanitation, social welfare, tribal welfare, education, forestry.

History of Universal Health Care/coverage (UHC):

• The slogan “Health for All by 2000” was proposed by Halfdan Mahler.
• It was endorsed by the World Health Assembly in 1977.
• This slogan had an inherent implication, i.e., “for All”, which means universalisation. Thus, nobody is denied this and everybody is eligible without being discriminated against on the basis of financial status, gender, race, place of residence, affordability to pay or any other factors.
• India, through its National Health Policy 1983, committed itself to the ‘Health for All’ goal by 2000.

Why haven't we achieved the goal of universal health care yet?

• A focus on primary care:
  • Only primary care was considered in the early phases of the “Health for All” strategy, with secondary and tertiary care left to the private sector.
  • For instance, the International Conference on Primary Health Care, at Alma Ata, 1978, listed eight components of minimum care for all citizens. It mandated all health promotion activities, and the prevention of diseases including vaccinations and treatment of minor illnesses and accidents to be free for all using government resources, especially for the poor.
  • Any non-communicable disease, chronic disease including mental illnesses, and its investigations and treatment were almost excluded from primary health care.

• Profit-oriented private-sector growth:
  • This abdication of responsibility, i.e., to provide secondary or tertiary care by the state, ensured the dominant, unregulated, profit-making private sector and also health insurance sector were kept happy and thriving. 
  • This created a dichotomy between peripheral primary and institutional-referred specialist care at the secondary and tertiary levels.
• Poor regulation of the private sector in poor and developing countries:
  • The Astana declaration of 2018 calls for “partnership” with the private sector, though alcohol, tobacco, ultra-processed foods, and industrial and automobile pollution contributed by the commercial private sector are well established. Also, poorer countries miserably fail or are unwilling for “private sector regulation”.
  • It never addressed poverty, unemployment and poor livelihood, but eulogises quality PHC only as the cornerstone for Universal Health Coverage and ignores broader Universal Health Care.
• The deceptive nature of the Universal Health Coverage slogan:
  • It is neither universal in its implementation nor comprehensive in its coverage of services and never assures accessibility or affordability as its financing is conditional to insurance premiums paid either by the individual or state.

Correcting the approach:

• The world soon realised the aforementioned shortcomings in the approach to universal health care and began taking corrective steps.
• For instance a Primary Health Care (PHC) Version 2 or Comprehensive PHC was defined. A sensible move, it was operationalised through the National Rural Health Mission (NRHM) in India from 2013.
• The second half of the last decade saw the operationalisation of the Health and Wellness Centre as a model of implementation of Comprehensive Primary Health Care.

Way forward:

• Every individual has a right to be healed and not have complications, disability and death. That right is guaranteed only by individualism in public health, the new global approach to UHC, where “nobody is left uncounted and uncared for”.
• The National Health Mission with concurrent intersectoral thrusts on Poshan Abhiyan, National Food Security, the Mahatma Gandhi National Rural Employment Guarantee Act, water sanitation, Sarva Shiksha Abhiyan, etc. is a better model of fully tax-funded Universal Health Care, but the Ayushman Bharat Jan Arogya Bhima Yojana damages that approach.