Universal health coverage: Current status and future roadmap for India

Abstract

Universal health coverage (UHC) has been recognized as the most important immediate goal for global health. Attempting to achieve this goal for the country, the Government of India, has been taking measured steps, trying to ensure equitable access to high-quality affordable health-care services for all citizens. This article attempts to identify the success of these efforts through a baseline situation assessment of UHC dimensions in India, followed by a critical analysis of what is being done to fulfill the gaps, and finally propose a health policy roadmap for UHC with implications at national and state level. Literature review presents a varied scenario with respect to the coverage of key services essential for service packages, reflecting need for significant improvement. Large-scale inequities in health-care service delivery and health indicators have been observed, with poor financial risk protection of the community from catastrophic spending on health care. Various reasons for this were identified, such as low public investment in health services, poor health-care service delivery system, poor quality of services offered to the community, and lack of robust financial protection mechanisms. The study proposes a contextual restructuring of the health system, initiating with an increase in financial investments in public health-care sector. This should be supplemented with health system strengthening by improving overall service availability for the community with optimal quality and at low cost. Private sector service provisioning should be regulated by developing and implementing strong accountability measures. The governance capacity of public sector should be augmented to improve success rates of the demand-side financing schemes. Health technology assessments should become the mainstay of taking decisions on benefit package. A holistic multipronged approach constituting all these changes is required if health coverage has to be made universal in the country.