Universal Health Coverage


  • The WHO defines health as a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.
  • At present, India’s health care system consists of a mix of public and private sector providers of health services.
  • Networks of healthcare facilities at the primary, secondary and tertiary levels, run mainly by State Governments, provide free or very low-cost medical services.
  • There is also an extensive private healthcare sector, covering the entire spectrum from individual doctors and their clinics to general hospitals and super speciality hospitals.

Health Status of India

With the second-largest population in the world, India is home to over 1.3 billion people.

  • With an average of two children born per woman in 2018, the country’s birth rate stood at 18.6 for every thousand inhabitants. In 2019, the average fertility rate for Indian women stood at around 2.2, that is, there were close to two children born per woman in the country that year. Despite a decreasing fertility rate, the total population of India is expected to increase over the next few years.
  • The average life expectancy has consistently increased since the 1920s and was around 69 years in 2017. However, this was still lower than the global average of around 72 years.
  • In 2019, the crude birth rate in India amounted to 17.64 live births per 1,000 inhabitants.
  • In 2017, the country’s death rate was recorded at about 7.2 deaths for every thousand inhabitants.
  • Infant mortality has also been on a steady decline over the years. In 2019, India’s infant mortality rate was about 28.3 deaths per 1,000 live births, a significant decrease from previous years.
  • India has the highest rate of excess female deaths, 13.5 per 1,000 female births, which suggests that an estimated one in nine deaths of females below the age of 5 may be attributed to postnatal sex selection. (UN Report, 2020)
  • India had the highest number of undernourished people in the Asia Pacific region. In 2018, there were approximately 189.2 million people who were undernourished in India.
  • 70 per cent of Indian women and 59 per cent of Indian men were unhealthy based on their diet and lifestyle. Heart disease has been one of the leading causes of death in India for over two decades, along with an increased propensity for cancer and diabetes. (2019)
  • India has made significant progress in reducing the number of vector-borne disease fatalities, but it remains a problem in many regions of the country. In 2017, the country recorded the highest number of malaria cases throughout the Asia Pacific region. Other life-threatening diseases that were prevalent in the country were dengue, typhoid, tuberculosis, and HIV-AIDS.
  • The share of mental health disorders among adults stood at around 14.3 per cent in 2017.

Universal Health Coverage

Universal Health Coverage is a means to promote the human right to health. UHC has been included in the new Sustainable Development Goals adopted by the UN. UN SDGs state that all UN Member States have agreed to try to achieve Universal Health Coverage by 2030. This includes financial risk protection, access to quality essential healthcare services, and safe, effective, quality and affordable essential medicines and vaccines for all.

It is the obligation of the state to provide free and universal access to quality healthcare services to its citizens.

Definition: World Health Organization defines universal healthcare as “all people and communities can use the promotive, preventive, curative, rehabilitative and palliative health services they need, of sufficient quality to be effective, while also ensuring that the use of these services does not expose the user to financial hardship.”

Challenges in achieving UHC in India

  • Largest disease burden in the world
  • Reproductive and child health problems, malnutrition
  • Issues of gender inequality
  • Commercialized, fragmented, and unregulated healthcare delivery systems
  • Imbalance in resource allocation, high out-of-pocket health expenditures
  • A rising ageing population, social determinants of health such as poverty, illiteracy, alcoholism etc.
  • Too frequent and too severe natural disasters
  • Lack of inter-sectoral coordination
  • Political pull and push of different forces and interests
  • Availability of Doctor: The doctor-to-patient ratio remains abysmally low, which is merely 0.7 doctors per 1,000 people. This is compared to the WHO average of 2.5 doctors per 1,000 people.
  •  Under-investment: Primary healthcare also means that PHCs continue to remain under-equipped and lack supplies and drugs to provide comprehensive primary care.
  • Insurance: Retail health insurance penetrates only a meagre 3.2 per cent of the 138 crore population. This leads to high out-of-pocket expenditures.
  • Rural-urban disparity: around 73% of hospitals are in urban areas just to serve around 32% population.
  • Infrastructure: The hospitals are understaffed and under-financed, forcing patients to visit private medical practitioners and hospitals.
  • Low Investment: The government spends only around 1.2% of its GDP on healthcare.
  • Governance: No single umbrella body governs the entire medical sector. The overlapping of functions and power results in a lack of accountability.
  • Focus on Tertiary Care: Huge focus on tertiary care instead of primary and secondary health care centres.
  • Lack of focus on health services to Women and children. They are the most vulnerable and neglected section of all.

Expected Outcomes from UHC

UHC outcome

Steps to Achieve UHC in India

It is possible for India, even within the financial resources available to it, to devise an effective architecture of health financing and financial protection that can offer UHC to every citizen.

  • Health Financing and Financial Protection: Government (Central and states combined) should increase public expenditures on health
  • Health Service Norms: Develop a National Health Package that offers, as part of the entitlement of every citizen, essential health services at different levels of the health care delivery system.
  • Human Resources for Health: Ensure adequate numbers of trained health care providers and technical health care workers at different levels by:
  • giving primacy to the provision of primary health care
  • increasing HRH density to achieve WHO norms of at least 23 health workers per 10,000 populations (doctors, nurses, and midwives).
  • Community Participation and Citizen Engagement: Organise regular Health Assemblies.
  • Access to Medicines, Vaccines and Technology: Strengthen the public sector to protect the capacity of the domestic drug and vaccines industry to meet national needs.
  • Management and Institutional Reforms: Introduce All India and state-level Public Health Service Cadres and a specialized state-level Health Systems Management Cadre to give greater attention to public health and strengthen the management of the UHC system.

Government Initiatives for UHC in India

  • National Health Policy 2017 envisages the attainment of the highest possible level of health without anyone having to face financial hardship consequently.
  • Mission Indradhanush, one of the largest global public health initiatives launched in 2014. In its four phases, MI has reached over 25 million children in over 528 districts.
  • Pradhan Mantri Dialysis Program has been launched to provide free services through Dialysis Units under Free Drugs and Diagnostics Program.
  • AMRIT outlets have been established to provide subsidised medicines
  • To provide comprehensive primary care, Government has announced transforming 1.5 lakh sub-health centres into Health and Wellness centres in the country.
  • Universal screening of common NCDs such as diabetes, hypertension and common cancers at the sub-centre and Primary Health Centre has been initiated.
  • Through two wings of Ayushman Bharat, Health and Wellness Centres (HWCs) and Pradhan Mantri Jan Aarogya Yojana (PMJAY), the government has been making quality healthcare affordable and accessible for crores of people in the country.
  • National Health Protection Scheme which aims to reach over 10 crore poor and vulnerable families.
  • Ayushman Bharat is a flagship scheme of the Government of India, was launched as recommended by National Health Policy 2017, to achieve the vision of Universal Health Coverage

The transformation of India’s health system to become an effective platform for UHC is an evolutionary process. The design and delivery of the UHC system require the active engagement of multiple stakeholders and calls for constructive contributions from diverse sectors. The need to create an efficient and equitable health system is so urgent (with the outbreak of Pandemics) that the task cannot be deferred any longer. We must rise to this challenge and usher in UHC, which the Indian people deserve, desire and demand.

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