Universal health coverage as a concept was born in 1883 when Germany introduced health coverage for achieving health status of its young population.India, is still attempting to find a way for providing appropriate, affordable and accessible health care to its population.
Universal health coverage (UHC) means that 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.
Understanding the concept of Universal Health Coverage (UHC) and how can we reach it, both globally and also in India. The presentation also includes HLEG report , which is the proposed architecture for India's guide to reach UHC.
Universal health coverage was established in the WHO constitution of 1948 declaring health a fundamental human right.The goal of universal health coverage is to ensure that all people obtain the health services they need without suffering financial hardship when paying for them.
Universal health coverage (UHC) is a vision where all people and communities have access to quality health services where and when they need them, without suffering financial hardship. It includes the full spectrum of services needed throughout life—from health promotion to prevention, treatment, rehabilitation, and palliative care—and is best based on a strong primary health care system.
Universal health coverage (UHC) means that 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.
Understanding the concept of Universal Health Coverage (UHC) and how can we reach it, both globally and also in India. The presentation also includes HLEG report , which is the proposed architecture for India's guide to reach UHC.
Universal health coverage was established in the WHO constitution of 1948 declaring health a fundamental human right.The goal of universal health coverage is to ensure that all people obtain the health services they need without suffering financial hardship when paying for them.
Universal health coverage (UHC) is a vision where all people and communities have access to quality health services where and when they need them, without suffering financial hardship. It includes the full spectrum of services needed throughout life—from health promotion to prevention, treatment, rehabilitation, and palliative care—and is best based on a strong primary health care system.
Understanding the concept of Universal Health CoverageHFG Project
Presented during Day One of the 2016 Nigeria Health Care Financing Training Workshop. Presented by Dr. Elaine Baruwa. More: https://www.hfgproject.org/hcf-training-nigeria
Universal Health Coverage (UHC) Day 12.12.14, NepalDeepak Karki
This presentation is made on the first ever Universal Health Coverage (UHC) Day 12.12.14 celebration in Nepal by Nepal Health Economics Association (NHEA).
Health economics is a branch of economics concerned with issues related to efficiency, effectiveness, value and behavior in the production and consumption of health and healthcare.
This is the product of compilation from various sources. I would like to acknowledge all direct and indirect sources although they have not been mentioned explicitly within the document.
Healthcare is a major part of every country's development platform. By healthcare we are in fact protecting the most important driver of development. Healthcare systems are primarily safe guarding the development core engine and are the best means of sustainable development.
Understanding the concept of Universal Health CoverageHFG Project
Presented during Day One of the 2016 Nigeria Health Care Financing Training Workshop. Presented by Dr. Elaine Baruwa. More: https://www.hfgproject.org/hcf-training-nigeria
Universal Health Coverage (UHC) Day 12.12.14, NepalDeepak Karki
This presentation is made on the first ever Universal Health Coverage (UHC) Day 12.12.14 celebration in Nepal by Nepal Health Economics Association (NHEA).
Health economics is a branch of economics concerned with issues related to efficiency, effectiveness, value and behavior in the production and consumption of health and healthcare.
This is the product of compilation from various sources. I would like to acknowledge all direct and indirect sources although they have not been mentioned explicitly within the document.
Healthcare is a major part of every country's development platform. By healthcare we are in fact protecting the most important driver of development. Healthcare systems are primarily safe guarding the development core engine and are the best means of sustainable development.
Article Type: Editorial
Title: Fairer world for a healthier and safer world
Year: 2021; Volume: 1; Issue: 1; Page No: 1 – 2
Author: Priyanka Raj CK
DOI: 10.55349/ijmsnr.2021.1112
Affiliation: Deputy Editor-In-Chief, IJMSNR, Associate Professor, Department of Public Health and Epidemiology, National University of Science & Technology, College of Medicine and Health Sciences, Sohar, Al Batinah North, Sultanate of Oman. Email ID: priyankaraj@nu.edu.om
Article Summary: Submitted: 02-August-2021
Revised : 30-August-2021
Accepted : 03-September-2021
Published: 30-September-2021
The slides are a point of statement on the feasibility of Universal health coverage. It talks about what is UHC and can it be sustained by India over time
“Sarvé bhavantu sukhinaḥ, sarvé santu nirāmayāḥ, Sarvé bhadrāṇi pashyantu, mā kashchid_duḥkha-bhāg-bhavét”. The meaning of this Sanskrit Sloka is “All should/must be happy, be healthy, see good; may no one have sorrow. Mahatma Gandhi also says, “It is health which is real wealth, and not pieces of gold and silver”. Without robust health nobody can do anything. WHO emphasized on “Health for all” in this 21st Century in Geneva Conference in 1998. Government of India also committed to the goal of ‘Health for All’. WHO defined “health” as "State of complete physical, mental, and social well being, and not merely the absence of disease or infirmity". There are strong linkages between population, health and development. India’s health challenges are not only huge in magnitude due to its large population but they are complex due to its diversity and the chronic poverty and inequality. There are extreme inter-state variations, caused by not only the cultural diversity but because -the states are at different stages of demographic transition, epidemiological transition and socio economic development. Along with the old problems like persistence of communicable diseases and high maternal mortality in some parts, there is an urgent need to address the emerging issues like the threat of non-communicable diseases, HIV (AIDS) and health problems of the growing aged population. Accelerating demographic transition is not only necessary for the population stabilization but it is closely related to health goals. Despite substantial improvements in some health indicators in the past decade, India contributes disproportionately to the global burden of disease, with health indicators that compare unfavorably with other middle-income countries and India's regional neighbours. Large health disparities between states, between rural and urban populations, and across social classes persist. A large proportion of the population is impoverished because of high out-of-pocket health-care expenditures and suffers the adverse consequences of poor quality of health care. The obligation of the Government of India is to ensure the highest possible health status to its population and access to quality health care has been recognized by a number of its key policy documents. This paper attempts to study the over view of health care in India.
Key words: Health Care, National Health Policy, Access, Affordability, Equity, Urban Vs Rural-------------
Prompted by the 20th anniversary of the 1993 World Development Report, a Lancet Commission revisited the case for investment in health and developed a new investment frame work to achieve dramatic health gains by 2035. Our report has four key messages, each accompanied by opportunities for action by national governments of low-income and middle-income countries and by the international community.
population medicine has been referred to as hygiene, public health, preventive medicine, social medicine or community medicine. All these aim for promotion of health and prevention of disease.
Pre-exposure prophylaxis (PReP) is the new tool to fight and prevent the spread of HIV. Its a very useful strategy to prevent HIV for those who indulge in high risk sexual behavior and unsafe sex.
FISH BONE DIAGRAM IS OFTEN USED FOR SOLVING PROBLEMS AND IS ALSO AN IMPORTANT TOPIC FOR M.D. COMMUNITY MEDICINE POST GRADUATES .THIS PRESENTATION COULD BE OF SOME HELP TO THEM .
The ppt is aimed at helping UG/PG students of medical and allied health sciences to understand the system of socio- economic classification and prevailing systems in India.The ppt has been updated till Jan 2018
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
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Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
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ASA GUIDELINE
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ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
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3. UNIVERSAL HEALTH COVERAGE
Also called as*
Universal Coverage
Social Health Protection
Universal Health Access
Universal Health Protection
3
*The world health report: health systems financing: the
path to universal coverage-2010
4. THE CONCEPT
Universal health coverage as a concept
was born in 1883 when Germany
introduced health coverage for
achieving health status of its young
population.
Later, in 2005, World Health Assembly
adopted the term "UHC" and in 2010,
World Health Report focused on health
systems financing for countries to build
a platform for UHC
4*HLEG
5. UHC is considered as a
standalone measure for
a country; as
conceptualized today
and attempts to provide
promotive, preventive,
diagnostic, curative and
rehabilitative services
without financial
hardships to its citizens.
The world health report:
health systems
financing: the path to
universal coverage-2010
5
The world health report: health systems financing: the
path to universal coverage-2010
6. DEFINITION:
Universal coverage (UC), or universal
health coverage (UHC), is defined as
“Ensuring that all people have access to
needed promotive, preventive, curative
and rehabilitative health services, of
sufficient quality to be effective, while also
ensuring that the use of these services
does not expose the user to financial
hardship”.
6
http://www.worldhealthsummit.org- 2013
7. This definition of UC embodies three
related objectives:
1. Equity in access to health services - those
who need the services should get them,
not only those who can pay for them;
2. that the quality of health services is good
enough to improve the health of those
receiving services; and
3. financial-risk protection - ensuring that the
cost of using care does not put people at
risk of financial hardship.
7http://www.worldhealthsummit.org -2013
8. 8
*The world health report: health systems financing: the
path to universal coverage-2010
9. Contd…
The global aspiration to
achieve UHC is evident as
countries having gross
domestic product (GDP)
less than that of India
have embarked upon and
adopted the concept.
China, Sri Lanka and
Bangladesh have also
adopted UHC and aim to
achieve 100% coverage in
times to come.
9
10. GLOBAL HEALTH SCENARIO AND
LEAD TO UHC
1948 Universal Declaration
of Human Rights states:
“Everyone has the right to a
standard of living adequate for
the health and wellbeing of
himself and of his family,
including food, clothing,
housing and medical care and
necessary social services.”
10
11. Contd.....
In 1966, member states
of the International
Covenant on Economic,
Social and Cultural
Rights recognised:
“the right of everyone to
the enjoyment of the
highest attainable
standard of physical and
mental health.”
11
http://www.refworld.org/docid/3ae6b36c0.html
13. Contd...
100 million people are
pushed into poverty
because of direct health
payments.*
79 countries devote less
than 10% of general
government expenditure to
health*
Health also frequently
becomes a political issue
as governments try to
meet peoples’
expectations
13*http://www.who.int/healthsystems/en/ Jun 2015
14. a. Member States of WHO
committed in 2005 to
develop their health
financing systems so
that all people have
access to health
services and do not
suffer financial hardship
paying for them.
b. This goal was defined as
universal coverage, or
universal health 14
15. The 2010 World
Health Report
builds upon the
2005 WHA
recommendations
and aims at
assisting countries
in quickly moving
towards Universal
Health Coverage.
15
17. India, is still attempting to
find a way for providing
appropriate, affordable and
accessible health care to
its population.
India was among the first
countries in the world that
enshrined in its constitution
the "socialist model of
health care for all”, being a
"Welfare state".
17
18. The Bhore Committee
suggested the norms at the
time of Independence for
implementing this
philosophy but till date
India has been struggling
to achieve "health care for
all".
Some progress was made
but the enormity of the task
presents huge challenges
for the public health system
across the country. 18
19. WHY IS HEALTH SYSTEM REFORM
NEEDED IN INDIA
19
18% of all episodes in rural
areas and 10% in urban areas
received no health care at all*.
28% of rural residents and 20%
of urban residents had no funds
for health care*.
Over 40% of hospitalized
persons have to borrow money
or sell assets to pay for their
care *.
*http://www.frontierweekly.com/articles/vol-46/46-51/46-
51-Health%20Coverage.html
20. Over 35% of hospitalized
persons fall below the poverty
line because of hospital
expenses* .
Over 2.2% of the population
may be impoverished because
of hospital expenses*.
The majority of the citizens who
did not access the health
system were from the lowest
income quintiles.
20
*http://www.frontierweekly.com/articles/vol-46/46-51/46-
51-Health%20Coverage.html
21. • India has Highest number of
malnourished and underweight
(46% under 3 yrs); children in
the world*
• Has high IMR of 50 per 1000
live births and MMR of 212 per
100 000 live births.*
• Has huge challenge to meet
national(MDG) goals of 28 per
1000 , (IMR) and 100 per 100
000 (MMR) by 2015.
Immunization coverage is
dismal > 44%*
21UHC: DR SABA
Source: World Health Organization (2011)
22. KEY HEALTH INDICATORS: INDIA COMPARED
WITH OTHER COUNTRIES
Indicator India China Brazil Sri Lanka
Thailand
IMR/1000 live-births 50 17 17 13 12
Under-5 mortality 66 19 21 16 13
Fully immunized (%) 66 95 99 99 98
Birth by SBA 47 96 98 97 99
(SKILLED BIRTH ATTENDANT)
22
Source: World Health Organization (2011)
23. Contd....
Rising burden of NCDs
2011 (in Millions) 2030 (in
Millions)
Diabetes 61 84
Hypertension 130 240
Tobacco Deaths 1+ 2+
23
Source: World Health Organization (2011)
24. Health situation is not
uniform across India.18 year
difference in life expectancy
between Madhya Pradesh
(56 years) and Kerala (74
years)
A girl born in rural Madhya
Pradesh, the risk of dying
before age 1 is around 6
times higher than that for a
girl born in rural Tamil Nadu
24
http://www.who.int/countryfocus/cooperation_str
ategy/ccs_ind_en.pdf
25. Health expenditure is
largely out of pocket
(OOP) 67%.
Public expenditure on
Health – 1.2% of GDP.
Lack of an efficient and
accountable public
health sector has led to
the burgeoning of a
highly variable private
sector.
25HLEG-2011
26. LOW PRIORITY TO PUBLIC SPENDING ON HEALTH
INDIA AND OTHER COUNTRIES : 2009
26
Total public
spending as %
GDP (fiscal
capacity)
Public spending
on health as % of
total public
spending
Public
spending on
health as % of
GDP
India 33.6 4.1 1.2
Sri Lanka 24.5 7.3 1.8
China 22.3 10.3 2.3
Thailand 23.3 14.0 3.3
http://uhc-india.org/reports/hleg_report_chapter_2.pdf
27. National programs like
National Rural Health
Mission (NRHM),
Rashtriya Swasthya
Bima Yojana (RSBY),
Janani Suraksha Yojana
(JSY), etc. have been
running in the country,
but they themselves are
insufficient to provide
and sustain UHC for the
nation at large.
27
28. With demographic transition,
rise in burden of NCDs is
another major area of
concern. Dual burden of
diseases in the country poses
huge economic losses. An
emerging economy like India
cannot afford such losses.
Therefore, urgent actions are
required to the reframe
existing infrastructure and in a
way to developments provide
UHC to the country.
28
30. Keeping in view the urgent requirement for
UHC , Planning Commission of India in
October 2010,constituted a High Level Expert
Group (HLEG) on Universal Health Coverage
(UHC):-
to develop a framework for providing easily
accessible and affordable health care to all.
review the experience of India’s health
sector
and suggest a 10-year strategy going
forward
30
31. 1. Develop a blue print for human
resource requirements to achieve
health for all by 2020.
2. Rework the financial norms
needed to ensure quality, universal
access of health care services,
particularly in under-served areas
and to indicate the relative role of
private and public service providers
in this context.
3. Suggest critical management
reforms in order to improve
efficiency, effectiveness and
accountability of the health delivery 31
32. 4. Develop guidelines for the
participation of
communities, local elected
bodies, NGOs, the private or-
profit and not-for-profit sector
in the delivery of health care.
5. Propose reforms in policies
related to the production,
import, pricing, distribution
and regulation of essential
drugs, vaccines and other
essential health care related
items, for enhancing their
availability and reducing cost .
32
33. Contd..
6. Explore the role of
health insurance
system that offers
universal access to
health services with
high subsidy for the
poor and a scope for
building up additional
levels of protection on
a payment basis.
33
34. EVOLUTION OF THE REPORT
Phase 1: An initial progress review
presented to the Planning
Commission at the end of January
2011.
Phase 2: Interim recommendations
developed by the HLEG at the end of
April 2011.
Phase 3: The final framework on
achieving Universal Health
Coverage for India was submitted on
the 21st of October, 2011
34
35. DEFINITION OF UNIVERSAL HEALTH
COVERAGE (UHC) BY HLEG
“Ensuring equitable access for all Indian
citizens, resident in any part of the country,
regardless of income level, social status, gender,
caste or religion, to affordable, accountable,
appropriate health services of assured quality
(promotive, preventive, curative and rehabilitative)
as well as public health services addressing
the wider determinants of health delivered to
individuals and populations, with the government
being the guarantor and enabler, although not
necessarily the only provider, of health and related
services.”
35
36. GUIDING PRINCIPLES FOR UHC
1. Universality
2. Equity
3. Non-exclusion and non-discrimination
4. Comprehensive care that is rational
and of good quality
5. Financial protection
36
37. 6. Protection of patients’
rights that guarantee
appropriateness of care,
patient choice, portability
and continuity of care.
7. Consolidated and
strengthened public
health provisioning.
8. Accountability and
transparency.
9. Community participation
&
10. Putting health in people’s
hands
37
38. UHC : FOCUS AREAS
38
1.Human Resource Requirements
2.Access to Health Care Services
3.Management Reforms
4.Community Participation
5.Access to Medicines
6.Health care Financing
7.Social Determinants of Health
39. ADDITIONAL FOCUS AREAS
39
8. Urban health
9. Female Gender
10. Public-Private Partnerships
11. Information Technology-enabled
Health services
41. 41
“Universal health entitlement for every
citizen - to a national health package
(NHP) of essential primary, secondary
& tertiary health care services funded
by the government”.
* Package to be defined periodically by an
Expert Group; can have state specific
variations
42. VISION OF HLEG FOR UHC
IT-enabled National Health Entitlement Card (NHEC)
42
44. PROVISIONING OF UHC
44
Strengthen Public Services
(Especially: Primary HealthCare- Rural
And Urban; District Hospitals)
Contract Private Providers (As Per
Need And Availability) – With Defined
Deliverables
Integrate primary, secondary and
tertiary Care through Network of
Providers (Public; Private; Public-
Private)
Regulate and Monitor For Quality,
Cost And Health Outcomes
45. PRE-REQUISITES
To achieve UHC, three basic prerequisites are of
paramount importance.
Firstly, sufficient resources are needed to cater for
the health service requirements.
Secondly, we need to reduce the financial risks and
barriers which obstruct the optimal usage of available
resources .
Thirdly, we need to focus on increasing the capability
of the population to effectively utilize the available
resources.
45HLEG-2011
46. Acknowledging the potential
of non-public sector in
achieving UHC.
HLEG recognizes that only
public sector cannot aim to
achieve UHC. Representation
from private sector is also
required to provide services.
These services can be
provided through two options.
46HLEG-2011
47. In the first option, all those private
providers who enroll themselves
under UHC will provide minimum
75% of outpatient department
services and 50% of in-patient
services to those entitled under
NHP.
The services will be cashless and
the provider will be reimbursed at
standardized rates.
For remaining portion of services
available, the institutions could
accept payments or provide
services through privately
purchased insurance policies.
47HLEG-2011
48. In the second option,
institutions enrolled under
UHC will provide only those
services, which are available
under NHP.
There are pros and cons of
both the options. Rigorous
monitoring and supervision
will be required for smooth
functioning of any of the
options.
48HLEG-2011
49. • However, HLEG
envisages that over time,
every citizen will be
issued an IT enabled
National Health
Entitlement Card
(NHEC)
• This will lead to greater
equity, improved health,
efficient and transparent
health system and
further reduction in
poverty, greater
productivity and financial 49HLEG-2011
51. Health finance is the
backbone of a self-sustaining
health care system.
The per capita health
expenditure of our country is
far less than that of Sri Lanka
and China and is around a
third of that in Thailand.
As a consequence, per capita
OOP expenditure in the
country has escalated to 67%
of total expenditure on health.
51HLEG-2011
52. Inequity among states as
far as public spending on
health (Kerala stands at
Rs. 498 when compared to
Rs. 163 in Bihar) further
suggests an urgent need
for substantial changes in
current health care system.
To streamline the health
care system, we need to
move from the concept of
insurance to assurance.
52HLEG-2011
54. 1:Central government
and states should
increase public
expenditures on
health from the
current level of 1.2%
of GDP to at least
2.5% by the end of
the 12th plan, and to
at least 3% of GDP
by 2022
54
56. 2: Ensure availability of free
essential medicines by
increasing public spending on
drug procurement.
3: Use general taxation as the
principal source of health
care financing –
complemented by additional
mandatory deductions from
salaried individuals and tax
payers, either as a proportion
of taxable income or as a
proportion of salary.
56
57. 4:Do not levy sector
specific taxes for
financing.
5:Do not levy fees of any
kind for use of health
care services under the
UHC.
6:Introduce specific
purpose transfers to
equalize the levels of
per capita public
57
58. 7: Accept flexible and
differential norms for
allocating finances so
that states can respond
better to their needs.
8: Expenditures on
primary health care,
should account for at
least 70% of all health
care expenditures.
58
59. 9:Do not use insurance
companies or any other
independent agents to
purchase health care
services .
10: Purchases of all
health care services
under the UHC system
should be undertaken
directly by the Central or
state governments .
59
60. 11:All government funded
insurance schemes should,
be integrated with the UHC
system.
All health insurance cards
should, in due course, be
replaced by National Health
Entitlement Cards.
The technical capacities
developed by the Ministry of
Labour for the RSBY should
be transferred to the Ministry
of Health and Family
Welfare.
60
62. 1:Develop a National Health
Package that offers every
citizen, essential health
services at different levels
of the health care delivery
system.
2.Develop effective
contracting-in guidelines
with adequate checks and
balances for the provision
of health care by the
formal private sector.
62
63. 3:Re-orient health care
provision to focus
significantly on primary
health care.
4: Strengthen District
Hospitals.
5: Ensure equitable access
to functional beds for
guaranteeing secondary and
tertiary care.
63
64. 6:Ensure adherence to
quality assurance
standards in the
provision of health care
at all levels .
7: Ensure equitable access
to health facilities in
urban areas by
rationalizing services and
focusing particularly on
the health needs of the
urban poor. 64
67. Millions of Indian households
have no access to medicines
as they can neither afford
them nor are these available at
government health facilities.
Almost 74% of private out-of-
pocket expenditures today are
on drugs.
Drug prices have risen sharply
in recent decades.
India’s domestic generic
industry is at risk of takeover
by multinational companies.
67
http://www.searo.who.int/publications/journals/seajph/is
sues/seajphv3n3p289.pdf
68. The market is flooded
by irrational, non-
essential, and even
hazardous drugs that
compromise health.
Despite available
expertise and
technology, health care
system has been facing
a huge challenge of
providing essential
medicines and vaccines
to those who require it.
68
69. Generic drug industry in India
provides lifesaving medicines
to many countries but at the
same time has been struggling
to increase access in our
country.
This has resulted largely from
lack of reliable drug supply
systems, irrational
prescriptions, stringent product
patent regimes as well as
limited availability of public
health facilities 69www.who.int/whr/en/report04_en.pdf
70. RECOMMENDATIONS
1:Enforce price controls and
price regulation especially on
essential drugs.
2:Revise and expand the
Essential Drugs List.
3:Strengthen the public sector
to protect the capacity of
domestic drug and vaccines
industry to meet national
needs.
70
71. 5: Set up national and state
drug supply logistics
corporations.
6:Protect the safeguards
provided by the Indian patents
law and the TRIPS Agreement
against the country’s ability to
produce essential drugs.
7:Empower the Ministry of
Health and Family Welfare to
strengthen the drug regulatory
system.
71
74. Required HRH were
recommended by Bhore
committee in 1948 up to
recent formulation of
Indian Public Health
Standards in 2010.
The country holds
largest number of
medical colleges than
anywhere in the world.
Despite this, the country
faces acute shortage of
HRH.
74
75. • In contrast to WHO
recommendation of 25
health workers per
10,000 population, India
stands at 52nd rank with
19 health workers per
10,000 population.
• The distribution of
medical colleges is
skewed with Kerala and
Bihar as extreme
examples. 75
76. In addition, the training
of health workforce
doesn’t address the
challenges of changing
dynamics of public
health.
This is apparent form
the fact that the time
allotted to Community
Medicine during
internship has been
reduced from 3 months 76
77. Launch of NRHM in 2005
gave a boost to the HRH
with creation of 8 lakhs
ASHAs with a target of
1/1000 population.
But, availability of
qualified practitioners is
lacking with gross
shortage of doctors and
nurses . 77
79. There are two implications of the
recommendations:-
1. It will result in a more equitable
distribution
of human resources
2. can potentially generate around 4 million
new jobs (including over a million
community health workers) over the next
ten years
79
80. 1:Increase HRH density to
achieve WHO norms of at
least 23 health workers per
10,000 population (doctors,
nurses, and midwives).
2.Establish a dedicated
training system for
Community Health
Workers under the aegis of
District Health Knowledge
Institutes(DHKIs)
80
81. 7:Establish State Health
Science Universities to award
degrees in health sciences
and prospectively add
faculties of health
management, economics,
social sciences and
information systems.
8:Establish the National Council
for Human Resources in
Health (NCHRH) to prescribe,
monitor and promote
standards of health
professional education.
81
83. • Structural and functional
improvements are
prerequisites for
achieving UHC in any
country.
• With the dismal state of
key health indicators,
there is a need to
regulate the vast private
sector existing in the
country. 83
84. There is a need to
provide adequate
hospital beds. As per
World Health Statistics,
India’s hospital bed
capacity has remained
among the lowest in the
world at 0.9 beds/1000
population against
average of 2.9
beds/1000 population
globally.
84planningcommission.nic.in/reports/genrep/rep_uhc2111.
86. Introduce All India and
state level Public
Health Service Cadres
and a specialized state
level Health Systems
Management Cadre in
order to give greater
attention to public
health and also
strengthen the
management of the
UHC system
86
MANAGERIAL REFORMS
HLEG 2011
87. INSTITUTIONAL REFORMS
Establish financing and
budgeting systems to
streamline fund flow: by
establishment of
National Drug
Regulatory Authority
(NDRDA) & National
Health Promotion and
Protection Trust
(NHPPT).
87HLEG 2011
88. a. National Drug Regulatory Authority
(NDRDA):
The main aim of NDRDA would be to
regulate pharmaceuticals and medical
devices and provide patients access to
safe and cost effective products.
b.National Health Promotion and
Protection Trust (NHPPT):
It will promote public awareness about
key health issues, track progress and
impact on the social determinants of
health, and provide technical expert
advice to the Ministry of Health
88HLEG 2011
90. Primary health care without
community participation is
incomplete.
For UHC, citizen engagement
needs scaling up for better
delivery of resources. ASHAs
have proved their worth under
NRHM.
NRHM has shown a positive
effect on mobilization of
community through civil
society organizations and
Panchayati Raj Institution
(PRIs). 90
ASHA WORKER
HLEG 2011
91. However, Village Health
and Sanitation
Committees and Rogi
Kalyan Samiti’s have
achieved limited
success.
In addition, lack of
knowledge of available
health services hampers
their optimal usage by
the population.
91HLEG 2011
92. Transformation of existing village
health committees into
participatory health councils is
required to be done.
92
94. UHC cannot be
achieved until we
address social
determinants of health.
The status of social
determinants including
nutrition, water and
sanitation, work security,
occupational health,
disasters, etc. remains
abysmal .
94www.who.int/contracting/UHC_Country_Support.pdf
95. RECOMMENDATIONS
1. Initiatives, both public and private, on the
social determinants of health and towards
greater health equity should be supported
2.A dedicated Social Determinants Committee
should be set up at the district, state and
national level
3. Include Social Determinants of Health in the
mandate of the National Health Promotion
and Protection Trust (NHPPT)
4.Develop and implement a Comprehensive
National Health Equity Surveillance
Framework, as recommended by the CSDH
95HLEG 2011
97. 1: Improve access to
health services for
women, girls and other
vulnerable genders
(going beyond maternal
and child health).
2:Recognize and
strengthen women’s
central role in health
care provision in both
the formal health system
and in the home. 97HLEG 2011
98. 3.Build up the capacity
of the health system to
recognize, measure,
monitor and address
gender concerns
through improved
monitoring .
4: Support and
empower girls, women
and other vulnerable
genders to realize their
health rights. 98HLEG 2011
100. Broad agreement on the
financing model for
health-care delivery.
Type and duration of
training for senior
functionaries in public
health,.
100
Challenge in fulfilling the objectives
of achieving UHC by 2022 :
101. Entitlement package
and the cost of
health-care
interventions.
Enactment of
National Health Bill
2009 as Health Act
and declining State
budget allocations for
public health.
101
104. The HLEG recommends having a
NHP. This will be through a
nationwide distribution of NHEC. A
difficult challenge as on December
2014, only 14.1% of Indians have
been issued PAN cards .
104http://www.incometaxindia.gov.in/PAN/Overview.
105. Looking toward
reimbursement to the
contracted-in private
hospitals the issue
itself will face a lot of
resistance.
As happened with
JSY, timely
reimbursement of
even Rs. 1400 for
beneficiaries was a
challenging issue.
105
107. The governments has
much higher capacities
to spend on health and
Political commitment
seems evident from the
fact that Prime Minister
of India, on the eve of
Independence day i.e.
15 Aug 2014 deaclred
health as “ Utmost
Priority.”
107
108. The Planning Commission has
acknowledged the same and recently
assured an increase in public health
spending to 2% of GDP from current
1.2% by end of 12th 5 years plan
108
109. Global experience has shown that
Universal Health-Care is affordable
and feasible.
Further, Clinical Establishments
(Registration Regulation) Act 2010,
Fundamental Right to Education Act
-2009 and Food Security Act- 2013
will help in reducing the burden of
illiteracy, poverty , unemployment and
disease .
109
110. CRITICAL ANALYSIS OF UNIVERSAL
HEALTH COVERAGE
People may not value free services.
Tax payers maybe unwilling to pay
extra taxes for the benefit of those who
cannot afford.
Services beyond the scope of the NHP
will have to be borne by the individuals.
Quality of services to those paying and
to the non-paying may differ.
State specific recommendations have
not been laid out.
110
112. The Indian people deserve, desire and
demand an efficient and equitable
health system which can provide UHC.
This needs sustained financial support,
strong political will and dedication of
public health functionaries and other
stake holders as well as active
participation of the community .
112
113. UHC is the way to move beyond health
care. It is the way for providing health
assurance to the country’s population.
Challenges are ahead but consistent
efforts can achieve the goal of UHC.
113
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116