This document discusses universal health coverage and provides information on key facts, definitions, objectives, and challenges. It summarizes the evolution of universal health coverage in India through various committee reports and schemes. Key recommendations from the High Level Expert Group report on achieving universal health coverage in India include establishing a national health package, developing health service norms, increasing human resources for health, strengthening community participation, and improving access to medicines and technology. Monitoring progress and overcoming challenges such as inadequate services, varying quality, and affordability issues are important to achieve universal health coverage.

1. UNIVERSAL HEALTH
COVERAGE
BY: Dr. MOHAMMADABAS RESHI
Department of Community Medicine
Govt. SKIMS Medical College Bemina
Srinagar,J&K India

2. UNIVERSAL HEALTH
COVERAGE
Health for all

3. CONTENTS
 KEY FACTS
 DEFINITION
 OBJECTIVE
 EVOLUTION OF UHC IN INDIA
 MONITORING
 CHALLENGES

4. KEY FACTS(Global)
• At least a billion people suffer each year because they
cannot obtain the health services they need.
• 100 million people are pushed below the poverty line
as a result of paying for the healthcare services they
receive.
• In the next twenty years, 40-50 million new healthcare
workers will need to be trained and deployed to meet
the need.

5. Contd……
All UN Member States have agreed to try to
achieve universal health(UHC) coverage by
2030, as part of Sustainable Development
Goal.
Over 800 million people(almost 12% of the
world’s population) spent at least 10% of their
household budgets to pay for healthcare.

6. Key facts( Indian picture)
• Highest number of malnourished children in the
world
• MMR – 212 /100,000 live births
• IMR ---- 39/1000 live births
‘India’s public financing for health care is less
than 1 per cent of the world’s total health
expenditure, although it is home to over 16 per cent
of the world’s population’
World Bank

7. Contd…
• Public expenditure on Health – 1.2 %
• Only about 17% of the population is covered
by some form of health insurance
• Health situation is not uniform across India
• 12 year difference in life expectancy between
MP ( 61.9 years) and Kerala ( 74 years)

8. Contd…
• MMR in Kerela is 81, but in Assam it is 390 per
100,000 live births
• Considerable gaps between rural and urban areas
with respect to disease morbidity and mortality.
Under nutrition is a dominant problem in the rural
areas while overweight and obesity accounts for half
the burden of malnutrition in urban areas.
• Urban areas have 4 times more health workers per
10,000 population than rural areas.

10. The Concept Decoded
 Universal: All people regardless of race, gender, social
status
 Health services: curative, health promotion, prevention,
rehabilitation, and palliative
 Quality: sufficient quality to be effective.
 Financial hardship: lowering out of pocket costs and
the risk of catastrophic health expenditure.

11. Dispelling myths about UHC
 UHC is not just health financing, it should cover all components of
the health system to be successful.
 UHC is not only about assuring a minimum package of health
services.
 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 comprised of much more than just health; taking steps
towards UHC means steps towards equity, development priorities
& social inclusion.

12. GOALS: Universal Health Coverage
All people may obtain health services they need without
suffering financial hardship when paying for them.
This requires:
 a strong, efficient, well-run health system;
 a system for financing health services;
 access to essential medicines and technologies;
 a sufficient capacity of well-trained, motivated health
workers.

13. Why Now?
 Health is a Cornerstone of sustainable development & global
security.
 The universal healthcare changes the way that healthcare is
financed & delivered- So it is more equitable & more effective.
 Because nobody should go bankrupt when they get sick.
 Because UHC is attainable
 Because UHC can stop the world’s biggest killers.
 Because health transforms communities, economics & nations.
 Because health is a Right, not a privilege.

14. Government expenditure to health
Governments need to give higher priority to health in
their budgets.
Innovative ways:
I. Improve tax collection mechanisms.
II. Introduce levies or taxes earmarked for health,
such as “sin” taxes on the sale of tobacco, alcohol
and ready to eat foods

15. Evolution of UHC in India
1. Bhore Committee 1946
2. Mudaliar Committee 1959-61
3. Jungalwalla Committee 1967
4. Kartar Singh Committee 1973
5. Shrivastava Committee 1975
6. Rural Health Scheme 1977

16. Contd….
7. Health for all by 2000, 1980
8. National Health policy, 1983
9. National population policy 2000
10. National healthpolicy 2002
11. NRHM 2005
12. NHM 2013
13. National Health Policy2015

17. High Level Expert Group Report India
• CONSTITUTED IN OCTOBER 2010
• REPORT IN NOVEMBER 2011

18. Defining UHC ( as per HLEG report)
 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.

19. Architecture for UHC ( as proposed by HLEG
1. Heath financing and Financial Protection
2. Health Service Norms
3. Human Resources for Health
4. Community participation and citizen engagement
5. Access to Medicines, vaccines and technology
6.Management and institutional reforms

20. 1. Heath financing and Financial Protection
 Health financing is concerned with how financial resources
are generated, allocated and used in health systems.
 Health financing policy focuses on how to move closer to
universal coverage with issues related to:
(i) how and from where to raise sufficient funds for health;
(ii) how to overcome financial barriers that exclude many poor
from accessing health services; or
(iii) how to provide an equitable and efficient mix of health
services

21. The Rashtriya Swasthya Bima Yojna
(launched in 2007) by the Ministry of Labour &
Employment
 Cashless coverage of all health services
Smart-card-based system;
 Only hospital admission and day-care
 Total of INR30000 insured per family below poverty
line per year.

22. Contd…
 • Pre-existing illnesses also covered;
 • Reasonable expenses for before and after hospital
admission for 1 day before and 5 days after;
 • Transport allowance (actual with limit of INR100 per visit)
subject to a yearly limit of INR1000
 • Only BPL Family
 • Up to five members for 1 year;
 • renewal yearly;
 • registration fee for a family is INR30;
 • Central government contribution 75% & State government
25% of the premium

23. 2. Health Service Norms
Present Indian Scenario
Indian Public health
Standard (IPHS) norms
prevailing among the
different levels of heath
facilities.
Recommendations by
HLEG
Develop a National
Health Package
 Lot of emphasis on
primary health care
IT-enabled National
Health Entitlement
Card(NHET)

24. 3. Human resource for health
Present Indian Scenario
 India is facing a crisis in human
resources for health
 2.2 million health workers which
roughly translates to a density of
22 health/10,000
 ASHA
 AYUSH
 Health workers are unevenly
distributed between the rural and
urban areas, and across states
Recommendations by
HLEG
 Increasing the number of trained
health care providers for
providing primary health care
 District Health Knowledge
Institutes (DHKIs)
 National Council for Human
Resources in Health (NCHRH) to
prescribe, monitor and promote
standards of health professional
education

25. 4.Community participation and citizen
management
Present Indian Scenario
Village Health, Nutrition
and Sanitation
Committee (VHNSC)
 Rogi kalyan samiti
(RKS)
Recommendations by
HLEG
 In order to improve community
participation, it recommended
transforming existing VHNSC into
participatory Health Councils.
 The Health Councils should organize
annual Health Assemblies at different
levels (district, state, and nation) to
enable community review of health
plans and their performance as well
as record ground level experiences
that call for corrective responses at
the systemic level.

26. 5.Access to Medicines, vaccines and Technology
Present Indian Scenario
There were 376
medicines listed in
National List of Essential
Medicine 2015.
 Jan Aushadhi
programme (2008)
 Mother & Child Tracking
System
Recommendations by
HLEG
 Revise and expand the
essential drugs list
 Enforce price regulation
especially on essential
drugs
 Ensure rational use of
drugs

27. 6. Management and institutional reforms (Recommendations by
HELG)
 • 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 (managerial reforms)
 Among Institutional reforms, it recommended the
establishment of the National Health Regulatory and
Development Authority (NHRDA) with three key units.:
1. System Support unit (SSU)
2. National Health and Medical Facilities Accreditation Unit
(NHMFAU)
3. Health System Evaluation Unit (HSEU)

28. Schemes to promote universal health coverage in India
 National Health Mission
Janani Suraksha Yojana
• The Rashtriya Swasthya Bima Yojna
• The Jan Aushadhi programme

29. NHM
 Increase of fund for public health from 0.9% of GDP to 1.8%
.of GDP in 2013
 To revitalize the public sector in health by increasing funding
Integration of vertical health and family welfare programs,
 Employment of female accredited social health activists in
every village,
 Decentralized health planning, community involvement in
health services,
 Strengthening of rural hospitals,
 Providing untied funds to health facilities,

30. Jan Aushadhi programme (2008)
public-private partnership,
Aim to set up in every district,
 To provide quality generic drugs and
surgical products at affordable prices 24
h a day

31. Global momentum for UHC
:1.MDG 2000
UHC and the Millennium Development Goals (MDGs)
are strictly connected.
UHC implies open access for all to health services,&
involves strengthening efforts to improve the quality,
availability & affordability of services linked to the
current MDGs including, for example, the fight against
HIV/AIDS, TB, malaria & child and maternal mortality.
Mental illnesses and injuries.

32. 2. Post- 2015 Development Agenda
Sustainable Development Goal ( SDG) 3
“ Ensure healthy lives and promote well being for all
at all ages”
SDG Target 3.8
“ Achieve UHC, including financial risk protection,
access to quality essential health care services and
access to safe, effective, quality and affordable
essential medicines and vaccines for all”

33. UHC MONITORING
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.
 Together with the World Bank, WHO has developed a
framework to track the progress of UHC by monitoring both
categories, taking into account both the overall level and the
extent to which UHC is equitable, offering service coverage
and financial protection to all people within a population, such
as the poor or those living in remote rural areas.

34. Current Scenario: A Global Movement towards UHC
 50 countries have attained universal or near universal
coverage
 Asia, Africa and the Middle East.
2010 World Health Report builds upon the 2005 World Health
Assembly recommendations:
 Highlights three basic requirements of universal health care:
• Raising sufficient resources for health
• Reducing financial risks and barriers to care,
• Increasing efficient use of resources

35. Contd…
WHO uses 16 essential health services in 4 categories as
indicators of the level and equity of coverage in countries:
Reproductive, maternal, newborn and child health:
family planning
antenatal and delivery care
full child immunization
health-seeking behaviour for pneumonia.

36. Contd…
Infectious diseases:
tuberculosis treatment
HIV antiretroviral treatment
Hepatitis treatment
use of insecticide-treated bed nets for malaria
prevention
adequate sanitation.

37. Contd…
Non communicable diseases:
prevention and treatment of raised blood pressure
prevention and treatment of raised blood glucose
cervical cancer screening
tobacco (non-)smoking.

38. Contd…
Service capacity and access:
basic hospital access
health worker density
access to essential medicines
health security: compliance with the
International Health Regulations.

39. Challenges for UHC
 1.Pursuing unrealistic goals.
UHC doesn't require a universally applicable
package of health care services that must be covered.
There is a problem that equal financial access that
may be facilitated by health insurance doesn't
necessarily mean equal physical access to high
quality health care.

40. Contd…
2. Problem with medicines:
a. Underuse of generic and higher than necessary prices for medicine
b. Use of substandard medicine.
c. Inappropriate and effective use of medicine.
3. Heath care products and services:
Overuse or supply of equipment, investigations and
procedures.
4. Heath workers:
Inappropriate or costly staff mix, unmotivated workers

41. CONTD…
 5. Health care services:
 Inappropriate hospital admissions and length of stay
 Inappropriate hospital size ( low use of infrastructure)
 Medical errors and suboptimal quality of care
 6.Heath system leakages: Waste, corruption and fraud
 7. Heath interventions: Inefficient mix/ inappropriate level of
strategies

42. UHC CHALLENGES SUM UP
 The availability of health care services provided by the public
and private sectors taken together is inadequate;
 The quality of healthcare services varies considerably in both
the public and private sector as regulatory standards for
public and private hospitals are not adequately defined and,
are ineffectively enforced; and
 The affordability of health care is a serious problem for the
vast majority of the population, especially at the tertiary level.

43. THANK YOU