Universal Health Coverage
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The Constitution of India, while not explicitly recognizing a 'Right to Health' as a fundamental right, implicitly guarantees it through Article 21, which states, 'No person shall be deprived of his life or personal liberty except according to procedure established by law.' The Supreme Court has interpreted 'right to life' to include the right to live with human dignity, encompassing the right to …
Quick Summary
Universal Health Coverage (UHC) is a global aspiration to ensure that all individuals receive the health services they need without suffering financial hardship. The World Health Organization (WHO) defines UHC through three core dimensions: who is covered (population), what services are covered (scope), and how much of the cost is covered (financial protection).
For India, UHC is a critical component of its social justice agenda and a key target under SDG 3. The National Health Policy (NHP) 2017 explicitly commits India to moving towards UHC, emphasizing a comprehensive approach that includes preventive, promotive, curative, rehabilitative, and palliative care.
The constitutional basis for UHC in India stems from the Supreme Court's interpretation of Article 21 (Right to Life) to include the Right to Health, and Article 47 (Directive Principle of State Policy) which mandates the state to improve public health.
India's flagship initiative for UHC is Ayushman Bharat, launched in 2018. It operates on two pillars: Pradhan Mantri Jan Arogya Yojana (PM-JAY), which provides a health cover of INR 5 lakh per family per year for secondary and tertiary care hospitalization to over 12 crore vulnerable families, and Ayushman Bharat Health and Wellness Centres (AB-HWCs), which aim to deliver Comprehensive Primary Health Care (CPHC) closer to communities.
As of March 2024, over 1.64 lakh AB-HWCs are operational, offering a wide range of services from maternal and child health to non-communicable disease screening.
Despite these efforts, India faces significant challenges, including low public health expenditure (around 1.2-1.5% of GDP), persistent shortages of healthcare professionals, infrastructure gaps, and high out-of-pocket expenditure (OOPE), which still accounts for nearly half of total health spending.
Recent developments, such as the Ayushman Bharat Digital Mission (ABDM) and increased budgetary focus on preventive health and frontline worker coverage, indicate a continued push towards strengthening the UHC framework.
The COVID-19 pandemic also underscored the urgent need for a resilient and equitable health system, reinforcing the importance of UHC.
- UHC: Access, Quality, Financial Protection (WHO).
- NHP 2017: India's UHC commitment, 2.5% GDP health spending target by 2025.
- Article 21: Right to Life includes Right to Health (SC interpretation).
- Article 47: DPSP, State's duty to improve public health.
- Ayushman Bharat (2018): Flagship UHC initiative.
- PM-JAY: 5 lakh/family/year, secondary/tertiary care, 12 Cr families.
- AB-HWCs: 1.64 lakh+ operational (March 2024), Comprehensive Primary Health Care (CPHC).
- ABDM (2021): Digital health ecosystem, ABHA IDs (50 Cr+ generated).
- OOPE: ~48% of total health expenditure (2019-20), major UHC barrier.
- Bhore Committee (1946): Laid philosophical foundation for universal healthcare.
- Health: State Subject (List II), Concurrent List for some aspects.
- SDG 3.8: UHC is a key target.
Vyyuha Quick Recall Mnemonic: ACCESS Framework for UHC
To remember the key components and challenges of Universal Health Coverage, use the ACCESS framework. This mnemonic helps structure your thoughts for a comprehensive answer, especially in Mains.
A - Access: Ensuring all people can reach health services. (Geographical, social, digital access) C - Coverage: What services are covered (Comprehensive Primary Health Care, secondary, tertiary) and who is covered (Population coverage).
C - Cost/Financial Protection: Reducing Out-of-Pocket Expenditure (OOPE) and providing financial security (e.g., PM-JAY). E - Equity: Addressing disparities based on socio-economic status, gender, geography.
(Fairness in health outcomes). S - Sustainability: Long-term financing, human resources, and infrastructure to maintain UHC. S - System Strengthening: Governance, quality assurance, digital health integration (e.
g., ABDM), public health infrastructure.
How to use it in a 200-word answer:
"Universal Health Coverage (UHC) is a critical goal for India, aiming to ensure health for all. Using the ACCESS framework, we can analyze its progress and challenges. Access to healthcare has improved through Ayushman Bharat Health and Wellness Centres (AB-HWCs), bringing services closer to communities.
The Coverage dimension is addressed by PM-JAY for secondary/tertiary care and AB-HWCs for Comprehensive Primary Health Care. Significant strides have been made in Cost/Financial Protection with PM-JAY reducing catastrophic health expenditures, though high OOPE remains a challenge.
Efforts are ongoing to enhance Equity, addressing disparities through targeted schemes. For Sustainability, India needs to significantly increase public health spending and develop human resources.
Finally, System Strengthening is crucial, leveraging digital health through ABDM and improving governance and quality of care. This holistic approach is vital for India's UHC aspirations.