- Universal health coverage (UHC) aims to ensure all people receive essential health services without financial hardship. This includes equitable access to promotion, prevention, treatment, rehabilitation and palliative care. - Key challenges to achieving UHC include half the world's population lacking full coverage of essential health services and over 800 million people spending over 10% of household budgets on health care. - India aims to achieve UHC through programs like Ayushman Bharat which establishes health and wellness centers and provides insurance coverage for secondary and tertiary care through Pradhan Mantri Jan Arogya Yojana (PM-JAY).

1. UNIVERSAL HEALTH
COVERAGE
Dr. ILA SINGH
BATCH 2014
INTERN CFM DEPT.
1

2. • KEY FACTS
• UHC: DEFINITION
• OBJECTIVES
• OOP
EXPENDITURE
• UHC CUBE
• AYUSHMAN
BHARAT YOJNA
• UHC & PHC
• PM-JAY
• CONCLUSION
2

3. KEY FACTS
• At least half of the world’s population still do not have
full coverage of essential health services.
• About 100 million people are still being pushed into
extreme poverty because they have to pay for health
care.
• Over 800 million people (almost 12% of the world’s
population) spent at least 10% of their household
budgets to pay for health care.
• All UN Member States have agreed to try to achieve
universal health coverage (UHC) by 2030, as part of the
Sustainable Development Goals. 3

4. UHC:Definition
• UHC means that all individuals and communities receive
the health services they need without suffering financial
hardship. It includes the full spectrum of essential,
quality health services, from health promotion to
prevention, treatment, rehabilitation, and palliative care.
4

5. • This definition of UHC embodies three related
objectives:
1. Equity in access to health services - everyone who
needs services should get them, not only those
who can pay for them;
2. The quality of health services should be good
enough to improve the health of those receiving
services; and
3. People should be protected against financial-risk,
ensuring that the cost of using services does not
put people at risk of financial harm.
5

6. 6

7. • UHC is firmly based on the WHO
constitution of 1948 declaring health a
fundamental human right and on the Health
for All agenda set by the Alma Ata
declaration in 1978.
7

8. 8

9. OUT OF POCKET EXPENDITURE
• Out-of-pocket payments for healthcare services
push 100 million people globally into poverty
every year.
• If people have to pay most of the cost out of
their own pockets, the poor will be unable to
obtain many of the services they need and even
the rich will be exposed to financial hardship in
the event of severe or long-term illness
9

10. • India is among the countries with unacceptably
high level of OOP expenditure.
• It must be recognized that outpatient care and
expenditure on medicines contribute the highest
fractions of OOP.
• The framework of UHC must, therefore
accommodate outpatient care and provision of
essential drugs within the ambit of public
financing.
10

11. Ensurethatdisadvantagedgroupsarenotleftbehind.
Theseincludelowincomegroupsandruralpopulation.
11

12. • Three dimensions of UHC:
• 1.Population coverage ( and equity)
• 2.Service coverage
• 3. Financial risk protection
12

13. UHC CUBE
13

14. FILLING THE CUBE
• The ultimate goal of the UHC is to move toward
filling more of the larger cube depicted above.
• Decision makers should recognize that progress
along only one of these axis is not sufficient.
• Therefore the best way to make progress towars
UHC is to involve all relevant
skateholders(including the general population) in
producing strategy that is most appropriate for
the countrty.
14

15. BASIC REQUIREMENT TO
PROVIDE UHC
1. Political will
2. Resources
3. Futuristic planning and effective
implementation
15

16. 16

17. WHOuses16essentialhealthservicesin4categoriesas
indicatorsofthelevelandequityofcoverageincountries
1.Reproductive, maternal, newborn and child health:
a) family planning
b) antenatal and delivery care
c) full child immunization
d) health-seeking behaviour for pneumonia.
2.Infectious diseases:
a) tuberculosis treatment
b) HIV antiretroviral treatment
c) Hepatitis treatment
d) use of insecticide-treated bed nets for malaria prevention
e) adequate sanitation.
17

18. 3.Noncommunicable diseases
a) prevention and treatment of raised blood pressure
b) prevention and treatment of raised blood glucose
c) cervical cancer screening
d) tobacco (non-)smoking.
4.Service capacity and access:
a) basic hospital access
b) health worker density
c) access to essential medicines
d) health security: compliance with the International Health
Regulations.
18

19. AYUSHMAN BHARAT YOJNA
• Ayushman Bharat or “Healthy India” is a national
initiative launched by Prime Minister Narendra
Modi as the part of National Health Policy 2017,
in order to achieve the vision of Universal Health
Coverage (UHC). This initiative has been
designed on the lines as to meet SDG and its
underlining commitment, which is “leave no one
behind”.
19

20. AyushmanBharatadoptsacontinuumofcareapproach,
comprisingoftwointer-related components,whichare:-
-
1.Establishment of Health and Wellness Centres–The first
component, pertains to creation of 1,50,000 Health and Wellness
Centres which will bring health care closer to the homes of the
people. These centres will provide Comprehensive Primary
Health Care (CPHC), covering both maternal and child health
services and non-communicable diseases, including free essential
drugs and diagnostic services.
2.Pradhan Mantri Jan Arogya Yojana (PM-JAY) –PM-JAY is one
significant step towards achievement of Universal Health
Coverage (UHC) and Sustainable Development Goal - 3 (SDG3).It
aims to provide health protection cover to poor and vulnerable
families against financial risk arising out of catastrophic health
episodes. 20

21. UHC & PHC
• Primary health care is the most efficient and cost
effective way to achieve universal health
coverage
• To ensure delivery of Comprehensive Primary
Health Care (CPHC) services, existing Sub Centres
covering a population of 3000 -5000 would be
converted to Health and Wellness Centres, with
the principle being "time to care" to be no more
than 30 minutes. Primary Health Centres in rural
and urban areas would also be converted to
HWC. 21

22. • The HWC at the Sub Health Centre level would be equipped and
staffed by an appropriately trained Primary Health Care team,
comprising of Multi-Purpose Workers (male and female)&ASHAs
and led by a Mid-Level Health Provider (MLHP). Together theywill
deliver an expanded range of services. In some states, sub health
centres have earlier been upgraded to Additional PHCs. Such
Additional PHCs will also be transformed to HWCs.
• A Primary Health Centre (PHC) that is linked to a cluster of
HWCswould serve as the first point of referral for many disease
conditions for the HWCs in its jurisdiction. In addition, it would also
be strengthened as a HWC to deliver the expanded range of
primary care services.
• The Medical Officer at the PHC would be responsible for ensuring
that CPHC services are delivered through all HWCs in her/his area
and through the PHC itself.
22

23. TheHWCwoulddeliveranexpandedrangeofservices.These
serviceswouldbedeliveredatbothSHCsandinthePHCs,whichare
transformedasHWCs.Thelevelofcomplexityofcareofservices
deliveredatthePHCwouldbehigherthanatthesubhealthcentre
level.
Expanded range of services
1. Care in pregnancy and child-birth.
2. Neonatal and infant health care services
3. Childhood and adolescent health care services.
4. Family planning, Contraceptive services and other
Reproductive Health Care services
5. Management of Communicable diseases including National
Health Programmes 23

24. 6. Management of Common Communicable Diseases and
Outpatient care for acute simple illnesses and minor
ailments.
7.Screening, Prevention, Control and Management of Non-
Communicable diseases
8.Care for Common Ophthalmic and ENT problems
9.Basic Oral health care
10.Elderly and Palliative health care services
11.Emergency Medical Services
12.Screening and Basic management of Mental health
ailments 24

25. AyushmanBharatisbasedonanambitiousprogrammeoftransforming
India's150000publicperipheralhealthcentresintohealthandwellness
centres(HWCs)deliveringuniversal,freecomprehensiveprimaryhealthcare
bytheendof2022.
25

26. Pradhan Mantri Jan Arogya Yojana
(PM-JAY)
• Pradhan Mantri Jan Arogya Yojana (PM-JAY) will provide financial
protection (Swasthya Suraksha) to 10.74 crore poor, deprived rural
families and identified occupational categories of urban workers’
families .It will have offer a benefit cover of Rs. 500,000 per family
per year.
• PM-JAY will cover medical and hospitalization expenses for almost all
secondary care and most of tertiary care procedures. PM-JAY has
defined 1,350 medical packages covering surgery, medical and day
care treatments including medicines, diagnostics and transport.
• To ensure that nobody is left out (especially girl child, women,
children and elderly), there will be no cap on family size and age in
the Mission. The scheme will be cashless & paperless at public
hospitals and empaneled private hospitals. The beneficiaries will not
be required to pay any charges for the hospitalization expenses. The
benefit also includes pre and post-hospitalization expenses.
26

27. • National Health Insurance Schemes
• Rashtiya Swasthiya Bima Yojana (RSBY)
• Employment State Insurance Scheme (ESIS)
• Central Government Health Scheme (CGHS)
• Aam Aadmi Bima Yojana (AABY)
• Janashree Bima Yojana (JBY)
• Universal Health Insurance Scheme (UHIS)
27

28. 28

29. CAN UHC BE MEASURED
• Monitoring progress towards UHC should focus on 2 things:
• The proportion of a population that can access essential
quality health services.
• The proportion of the population that spends a large amount
of household income on health
29

30. 30

31. CONCLUSION- DISPELLING
MYTHS ABOUT UHC
• UHC does not mean free coverage for all possible health
interventions, regardless of the cost, as no country can
provide all services free of charge on a sustainable basis.
• UHC is not just about health financing. It encompasses all
components of the health system: health service delivery
systems, the health workforce, health facilities and
communications networks, health technologies,
information systems, quality assurance mechanisms, and
governance and legislation.
• UHC is not only about ensuring a minimum package of
health services, but also about ensuring a progressive
expansion of coverage of health services and financial
protection as more resources become available. 31

32. • UHC is not only about individual treatment
services, but also includes population-based
services such as public health campaigns, adding
fluoride to water, controlling mosquito breeding
grounds, and so on.
• UHC is comprised of much more than just
health; taking steps towards UHC means steps
towards equity, development priorities, and
social inclusion and cohesion.
32

33. 33

34. THANK YOU
34