Need for a Universal Health Coverage

Challenges for an Universal Health Coverage in India


Swati Sudhakaran@TheMindMap

A new global index to assess the development of countries in meeting their SDG goals has indicated that India ranks 143 among 188 countries in health index. Many Indians may be happy with this because we rank better than Pakistan and Bangladesh, but we are, in fact, placed below countries like Syria, Iraq and Ghana.

If the aim was to turn the healthcare into an export sector to advance medical tourism, we have succeeded with our 5 star hospitals and cost effective treatment to people.The medical tourism industry according to the Confederation of Indian Industries is at $3 billion as of October 2015 and is expected to touch $7-8 billion by the end of 2020.

But Universal Health Coverage (UHC) still eludes Indians. The BJP, in its manifesto, had promised health assurance to all Indians and vowed to reduce out-of-pocket expenditure on healthcare. Presently, the government spends on average Rs 4,895 per year on every person covered under CGHS (who are a few million), while the average public spending for the health of all Indians (who are some 1,250 million) is about a fifth of that. Policymakers need to get out of the scandalous selective choosing of whom to cover and hence should actively push for a UHC.


India’s public expenditure on health at 1.4 per cent of the GDP is one of the lowest among the SEARO countries, with Myanmar being the only exception. It is also the lowest among the BRICS countries.

Governments of UK and Thailand have successfully implemented UHC with both its underlying characteristics- good quality healthcare and of not exposing citizens to financial strains during treatment.

WHO recommendation of one doctor for one thousand people, we have one doctor for 1450 people. With this ratio, nearly a quarter of the posts are lying vacant and the situation is all the more severe in rural areas which have a deficit of six lakh doctors. The doctor population ratio in rural India is about 1:3200. The situation here, is worse than Vietnam and African countries like Algeria.

India is among the 194 countries that are aiming to attain Universal Health Coverage (UHC) by 2030 under the commitment to attain Sustainable Development Goals (SDGs).

The state of healthcare has deteriorated to the extent that one serious illness in a middle class family can push it below the poverty line. Poverty caused by medical expenditure is increasing significantly in both urban and rural India. Recently, there was a news report that in Mumbai, an individual may have to spend two years of his family’s annual income for treating a disease like TB.

The country at present suffers from the triple burden of disease — the unfinished agenda of infectious diseases; the challenge of noncommunicable diseases (NCDs), linked with lifestyle changes; and emergence of new pathogens causing epidemics and pandemics.

Nearly 60 per cent of the total health expenditure is incurred by patients directly for which there is no provision for reimbursement or insurance. It shows that it is imperative for India to have a well-designed health insurance scheme which will act as a safety net for these people. The formulation of relevant healthcare policies with effective tools for implementation and monitoring are the need of the hour. We are losing six per cent of our GDP to preventable illness and premature deaths.

WHO has designed a Universal Health Coverage Profile for member countries entailing four parameters of assessment.


The first parameter is reproductive, maternal, newborn and child health. According to data from the Health Ministry, India loses over 44,000 women to pregnancy-related complications every year, which means one woman dies every 12 minutes for want of care.

The second parameter is the country performance on tackling infectious diseases. Only 39.5 per cent of the population has access to improved sanitation.  Only 41.4 per cent population seeks tuberculosis detection and treatment facilities while 44 per cent population is covered under HIV detection and treatment facilities.

The third factor is the burden of non-communicable diseases. About 30 per cent Indians have high blood pressure. Lifestyle diseases are cropping up faster than usual, spiking the numbers.

The fourth component of the assessment includes basic hospital access, density of health workers, access to essential medicines, and compliance with international health regulations. India has only six hospital beds per lakh and close to two surgeons per lakh population.

Data or rather accurate data is a source of empowerment. On 12th December, i.e. Universal Health Coverage day as commemorated by WHO, a data portal system was launched to keep a track of the progress towards UHC and also to indicate the points at which countries needed improvement.

It is important for policymakers to address how the spending needs to be done on universal healthcare rather than how much.

Swati Sudhakaran is currently pursuing Masters in Public Policy in Mount Carmel College in collaboration with the Takshashila Institution.

Author: TheMindMap

Books Are Life period. Crazy over Coffee, dog lover, in a love hate relationship with self, taking teeny weeny steps into the arena of policymaking. Phew!

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