Universal Health Coverage.pptx

Current scenario and Significance
towards achieving Universal Health
Coverage
DR. Sanjay Kumar
Prof. and Head
Department of community Medicine,
IGIMS, Patna

Framework
 Universal health coverage
• Objectives
• Dimension
 Evolution in world and Indian context
 Current Scenario
 Myths about UHC
 Vision for UHC : HLEG
 Expected outcome
 The New Architecture For UHC: Way Forward

WHO theme for 2018 & 2019
Universal Health
Coverage:
Everyone,
Everywhere

What is UHC?
 All individuals and communities receive the health services
they need without suffering financial hardship
 Includes full spectrum of essential, quality health services,
from health promotion to prevention, treatment,
rehabilitation and palliative care

Objectives : Universal Health Coverage
Equity in access to health services
Quality of health services
Financial-risk protection

Why Universal Health Coverage?
Historical background:
Alma Ata Declaration of 1978
2005-12: all nations have made the
commitment to achieve universal
health coverage
"everyone should have access to
the health services they need
without risk of financial ruin or
impoverishment"
a powerful mechanism for
achieving better health and well-
being, and for promoting human
development.

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.

Global Momentum for UHC
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”

Making progress towards UHC is a policy priority for both
countries and global institutions
 Highlighted by the agenda of the UN Sustainable
Development Goals (SDGs) adopted in 2015,
reaffirming high-level political commitment to UHC and
outlining a number of necessary actions in 2019 and
 WHO’s Thirteenth General Programme of Work
(GPW13),2025 target (1billion more people benefit from
UHC, while also contributing to the 2 other billion
targets of 1billion more people better protected from
health emergencies and 1 billion more people enjoying
better health and well-being.)

 In 2018, Global Conference on Primary Health Care, 40
years after the adoption of the historic Declaration of
Alma-Ata. came together to recommit to primary health
care as the cornerstone of UHC in Declaration of
Asthana.
 The Declaration aims to renew political commitment to
primary health care from governments, non-
governmental organizations, professional organizations,
academia and global health and development
organizations.

 In 2020, the second UHC Forum, aiming to enhance political
momentum on UHC in international fora.
 Twelve co-signatories including the WBG also launched the
Global Action Plan for Healthy Lives and Well-being for All
(GAP) to jointly support countries in delivering on the SDG3
targets.
 Some of WHO’s partnerships for support to advance UHC
include:
 UHC2030
 Alliance for Health Policy and Systems Research
 P4H Social Health Protection Network
 UHC Partnership
 Primary Health-Care Performance Initiative

UHC emphasizes not only what services are covered, but
also
 How they are funded, managed, and delivered
 Investments in quality primary health care will be the
cornerstone for achieving UHC around the world.
 Achieving UHC requires multiple approaches.
 The primary health care approach and life course
approaches are critical

Tracking UHC
UHC monitoring done by WHO and the World Bank developed UHC
monitoring framework,
• Based on a series of country case studies technical reviews
• Consultations and discussions with country representatives
• Technical experts and
• Global health and development partners.

The framework focuses on the key components of UHC:
Coverage of the population with quality, (affordable, quality health
particularly to women, children, adolescents and people affected by
mental health issues)
Essential health services prevention (services for health promotion
and illness prevention) and treatment ( treatment per se, but also
rehabilitation and palliative care services) and
Coverage of the population with financial protection.(incidence of
impoverishment resulting from OOP health payments, and the
incidence of financial catastrophe from the same cause. )

BACKGROUND - INDIA
• First concrete step:
- During planning process of 12th Five Year Plan: widely
termed as Health Plan
• Planning commission constituted a High Level Expert Group
on UHC 2010
• Mandate: Developing a framework for providing easily
accessible and affordable health care to all Indians
• HLEG also recommended Appropriate Health Care Financing
as key strategy to achieve UHC

 To address the policy challenges and fill critical gaps in
achieving UHC, the National Health Policy (NHP)-2017 had
been approved by the Union Cabinet.
 To translate its vision of the NHP-2017 into reality, the
Government of India has approved Centrally Sponsored
Ayushman Bharat-National Health Protection Mission
(AB-NHPM)

Schemes to Promote UHC in India
National Health Mission
Janani Suraksha Yojana
The Rashtriya Swasthya Bima Yojna
The Jan Aushadhi Programme

Universal Health Coverage Global Index
Source : Lozano, Rafael & Fullman, Nancy & Mumford, John & Knight, Megan & Barthelemy, Celine & Cristiana, Abbafati & Abbastabar, Hedayat & Abd-Allah, Foad & Abdollahi, Mohammad & Abedi, Aidin & Abolhassani,
Hassan & Eshete, Akine & Guimarães Abreu, Lucas & Abrigo, Michael & Haimed, Abdulaziz & I. Abushouk, Abdelrahman & Adabi, Maryam & Oyabeda, Ijemidalo & Adekanmbi, Victor & Murray, Christopher. (2020).
Measuring universal health coverage based on an index of effective coverage of health services in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. The
Lancet. 396. 1250-1284. 10.1016/S0140-6736(20)30750-9.

Source : Lozano, Rafael & Fullman, Nancy & Mumford, John & Knight, Megan & Barthelemy, Celine & Cristiana, Abbafati & Abbastabar, Hedayat & Abd-Allah, Foad & Abdollahi, Mohammad
& Abedi, Aidin & Abolhassani, Hassan & Eshete, Akine & Guimarães Abreu, Lucas & Abrigo, Michael & Haimed, Abdulaziz & I. Abushouk, Abdelrahman & Adabi, Maryam & Oyabeda,
Ijemidalo & Adekanmbi, Victor & Murray, Christopher. (2020). Measuring universal health coverage based on an index of effective coverage of health services in 204 countries and territories,
1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. The Lancet. 396. 1250-1284. 10.1016/S0140-6736(20)30750-9.

Current Scenario
2017 UHC Global Monitoring Report
According to this report, much remains to be done to achieve
UHC:
At least half of the world’s population does not have
access to quality essential services to protect and
promote health
 800 million people spending 10% of their household
budget on out-of-pocket health care expenses
Nearly 100 million people being pushed into extreme
poverty each year due to health care costs

Grey areas
Primary health services are a fundamental element of UHC,
yet research warns that, if current trends continue, up to 5 billion
people will still be unable to access health care in 2030.
Maternal and child mortality remain high in several parts of the
world, more than a fourth of girls and women in Sub-Saharan Africa
cannot access family planning services, fueling unplanned
pregnancies and maternal, infant and child mortality and morbidity.
World Bank report showing that people in developing countries
spend half a trillion dollars annually — over $80 per person — out of
their own pockets to access health services, hit the poor the hardest
and threatening decades-long progress on health.

World Bank/World Health Organization (WHO) research from
2019 shows countries must increase spending on primary
health care by at least 1% of their gross domestic product
(GDP) to close coverage gaps and meet the health targets
under the SDGs.
A lack of universal access to quality, affordable health services
endangers countries’ long-term economic prospects and makes
them more vulnerable to pandemic risks.

Why Is Moving Towards UHC Important?
HEALTH BENEFITS
Better access to necessary care & improved
population health, with the largest gains accruing to poorer
people
ECONOMIC BENEFITS
POLITICAL BENEFITS

Importance of Universal Health Coverage

Think BOLDLY & STRENGTHEN Financing for UHC

Financial risk protection is patchy
Where out-of-pocket expenditure is high in relation to total health
expenditure; 150M people suffer catastrophic expenditure each year
Source: WHO

Dispelling Myths about UHC
 To be successful - Not just financing, should cover all
components of health system
 Not only about assuring a minimum package of health
services
 Its not about just health.......Its a step towards......
EQUITY,
DEVELOPING PRIORITIES,
SOCIAL INCLUSION &
COHESION

Vision for UHC : HLEG
Universal Health Coverage by 2022:
The Vision
ENTITLEMENT
Universal Health
entitlement to
every citizen
CHOICE OF FACILITIES
People free to choose
between
Public sector facilities
Contracted-in private
providers
NATIONAL HEALTH
PACKAGE
Guaranteed access to an
essential health package
(including cashless in-patient &
out-patient care provided free-
of-cost)
Primary care
Secondary care
Tertiary care

THE NEW ARCHITECTURE FOR UHC:
6 CRITICAL AREAS:
1. Health Financing and Financing 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

1. Health Financing and Financing
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

Health Financing and Financing
Protection (Contd..)
Present Indian scenario Recommendations by HLEG
1. The Government spending on 1. Increase public expenditures on
healthcare in India is only 1.04% of health from the current level of GDP
GDP which is about 4 % of total Government to at least 2.5% by the end of 12th
expenditure, less than 30% of total plan (2012-17) and to at least 3% of
health spending GDP by 2022.
2. JSY (2005) 2. Use general taxation as the principal
source of health care financing
3. Chiranjeevi yojna (2006)
4. Rastriya Swasthya Bima Yojna (2008)

Rastriya Swasthya Bima Yojna (2008)
• (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
• Pre-existing illnesses also covered
• Reasonable expenses for before and after hospital admission for 1 day
before and 5 days after

Rastriya Swasthya Bima Yojna
(2008) (Contd..)
• 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 INR 30
• Central government contribution 75% & State government 25% of the
premium

2. Health Service Norms
1. Indian Public health Standard 1. Develop a National Health
(IPHS) norms prevailing among Package
the different levels of heath 2. Lot of emphasis on
facilities. primary health care
3. IT-enabled National
Health Entitlement Card
(NHET)

3. Human Resources for Health
1. India is facing a crisis in human 1. Increasing the number of trained
resources for health health care providers for
2. 2.2 million health workers which providing primary health care
roughly translates to a density of 2. District Health Knowledge
22 health/10,000 Institutes (DHKIs)
3. ASHA 3. National Council for Human Resources
4. AYUSH in Health (NCHRH) to prescribe,
5. Health workers are unevenly monitor and promote standards of
distributed between the rural and health professional education.
urban areas, and across states

4. Community Participation and Citizen
Engagement
1. Village Health, Nutrition and 1. In order to improve community
Sanitation Committee (VHNSC) participation, it recommended
2. Rogi Kalyan Samiti (RKS) transforming existing VHNSC
into participatory Health Councils
2. 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.

5. Access to Medicines, Vaccines
and Technology
1. There were 376 medicines 1. Revise and expand the essential
listed in NLEM 2015 drugs list
2. Jan Aushadhi programme (2008) 2. Enforce price regulation
especially on essential drugs
3. MCTS 3. Ensure rational use of drugs

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)

EXPECTED OUTCOME FROM UHC
Universal
Health
Coverage
Greater
equity
Efficient
accountable
&transparent
health system
Reduction
poverty
Greater
productivity
Increased
jobs
Improved
health
outcomes
Financial
protection

Envisioning the Future: Seeking Stability & Health
Protection in the Midst of Multiple Transitions
• Demographic transition
• Epidemiological & Nutritional Transitions
• Managerial Transitions
• Political Transitions
• Federal Nature of India’s Policy
In conceptualizing a UHC system, a focus on India’s future
will be crucial to ensure the implemented system is able to
exist in, make the best of and respond to the country’s
changing demographic, health, political and economic
scenario

Way forward
 Strengthen regulatory framework and
institutions (such as Insurance
Regulator and Development Authority
and Competition Commission of India)
 Synergy between AB-NHPM and Health
and Wellness Centres

The growth of research…
for universal health coverage

Universal Health Coverage.pptx

Universal Health Coverage.pptx

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