Universal health coverage (UHC) signifies universal accessibility to comprehensive, high-quality health services, without financial hardship. UHC ensures that people receive care whenever and where ever they need it. It covers the full continuum of essential health services, from health promotion to prevention, treatment, rehabilitation, and palliative care. The delivery of these services relies on strong, efficient, and equitable health systems deeply rooted in the communities. UHC is built on the ethos of strengthening primary healthcare to ensure that all health needs are addressed in an integrated manner, supported by a well-equipped health and care workforce.
On December, 12, 2012, the UN General Assembly unanimously endorsed a resolution urging countries to accelerate progress towards UHC. In India, the high level expert group report, submitted to the Planning Commission in 2011, outlined a government intent to increase public financing for health to 2.5% of India’s GDP during the 12th Plan (2012-17). The economic growth of the country makes this increase feasible. The National Health Policy, 2017 articulates “the attainment of the highest possible level of good health and well-being, and universal access to good quality health care services without anyone having to face financial hardship as a consequence” as its goal, which aligns with the UHC target.
Right to health
India lacks a constitutional provision for the fundamental right to basic health. However, the Directive Principles of State Policy in Part IV of the Constitution provides a basis for the right to health. Article 39 (e) of the Constitution directs the state to secure the health of workers; Article 42 emphasises just and humane conditions of work and maternity relief; and Article 47 casts a duty on the state to raise the nutrition levels and standard of living, and to improve public health. The Constitution not only mandates the state to enhance public health but also endows the panchayats and municipalities to strengthen public health under Article 243G.
The theme of International UHC day is ‘Health for all: Time for Action’ and of World Health Day is ‘my health – my right’. How should access to health be envisaged? Given that health is a state subject and the UHC policy is envisaged at the national level, there is a need for discourses on implementation. India has a large migrant population: the total number of inter-State migrant workers was about 41 million (Census 2011), and the total migration rate was 28.9% (Periodic Labour Force Survey, 2020-21). With 49% of the population living in urban slums, according to UN-Habitat/World Bank, the focus should be on ensuring the availability and accessibility of primary health services.
Isaiah Berlin spoke about two types of freedom. The first is ‘freedom from’ or negative freedom; the second is ‘freedom to’ or positive freedom. ‘Freedom from’ means the absence of obstacles or constraints, whereas ‘freedom to’ recognises the possibility of autonomously determining and achieving individual or collective purposes. The discourse on health as a human right must be seen as the second freedom, where every citizen has the possibility to achieve health and wellness as part of their rights to access to public health.
The constitutional right to health is critical to breaking the vicious cycle of poverty and poor health that will otherwise continue to perpetuate inequality in all spheres of life, including education, opportunity, wealth, and social mobility.
The two critical components of the UHC policy — strengthening primary healthcare and reducing out-of-pocket expenditure — demand focused attention. To align electoral mandates with UHC implementation, political leaders should consider the following suggestions.
Four suggestions
The first is to address urban migrants’ health needs, and reforms in informal sectors. Given the surge in migration and mobility, primary healthcare needs a shift in vision. There is a need to include the element of mobility and portability of access to health care services to aid continuity of treatment.
The second is to simplify the reimbursement processes for reducing out-of-pocket expenditure. The design of cash transfers and reimbursement in India’s public healthcare system needs adaptation for migrant and marginalised communities.
The third is to create inclusive health systems. We need to integrate health management information system dashboards with both public and private systems and ensure better information systems considering language barriers and diversity in the urban context.
The fourth is to implement community-based primary healthcare in urban and peri-urban areas with seamless referral systems. We need to foster integration of services at the primary healthcare level, ensuring follow-up and adherence to healthcare.
A healthy population is an empowered population. The lighter the disease burden, the better the country’s financial health. This election, UHC can be a transformative offering of political parties. Committing to investing in health systems and effectively implementing UHC necessitates political will, substantial investment, and a clear, long-term vision. Establishing a coherent policy pathway to execute the national UHC policy consistently across States is imperative for its success.
Aruna Bhattacharya leads the urban health/public health domain at the School of Human Development, Indian Institute for Human Settlements, Bengaluru.
