Universal Health Coverage


About tHE tHEME

The goal of Universal Health Coverage is to ensure that all people obtain the 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; and a sufficient capacity of well-trained, motivated health workers.

Ensuring that every individual in this diverse nation obtains the needed health services without suffering financial hardship

Ensuring that every individual in this diverse nation obtains the needed health services without suffering financial hardship 

The National Rural Health Mission (NRHM) launched by the Government of India in 2005 seeks to provide accessible, affordable and quality health care to the rural population, especially the most vulnerable. It also sought to reduce the Maternal Mortality Ratio in the country from 407 to 100 per 100,000 live births. Infant Mortality Ratio from 60 to 30 per 1000 live births and the Total Fertility Rate from 3.0 to 2.1 within the seven year period of the Mission.

 

Now, the NRHM along with the recently launched National Urban Health Mission (NUHM)  has been subsumed under the National Health Mission (NHM). Despite significant progress especially since the launch of NRHM, challenges remain:

  • 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.

Figure 1: Out-of-pocket Health Expenditure as proportion of Total Health ExpenditureDue to the lack of extensive and adequately funded public health services, a large proportion of the population incurs heavy out-of-pocket (OOP) expenditure on services purchased from the private sector. Figure 1 shows that the OOP expenditure as a proportion of total health expenditure is a very high 61.7 per cent in India as compared to the global average of 20.5 per cent.

 

The total expenditure on health care in India, including public and private expenditure is broadly comparable to other developing countries at similar levels of per capita income. The total expenditure on health care (both public and private together) is 3.7 per cent of the GDP.  Figure 2: Government Health Expenditure as proportion of GDPHowever, according to the World Health Statistics 2013, public expenditure on health is very low constituting 28.2 per cent of total health expenditure According to the Government of India’s 12th Five Year Plan, public health expenditure in India was only 1.04 per cent of GDP in 2011–12 as compared to the global average of 5.4 per cent (See Figure 2)

 

The Union Government’s Ministry of Finance disburses funds to the Ministry of Health and the States. The public sector also funds a number of insurance schemes. Currently, Union-funded insurance schemes cover an estimated population of 181 million through the Employee State Insurance Scheme (ESIS) - (60 million); Central Government Health Scheme (CGHS) - (3 million) and Rashtriya Swasthya Bima Yojana (RSBY) - (118 million). While ESIS and CGHS provide for comprehensive health care, RSBY provides for only hospitalization cover with a benefit limit of INR 30,000 (US$ 500 approximately) per enrolled household per year (See Figure 3).Figure 3: Population coverage under various health schemes in India In addition, 110 million people in the South Indian states including 70 million in Andhra Pradesh; 35 million in Tamil Nadu and 5 million in Karnataka receive coverage under state government funded health insurance schemes. However, most of these schemes cover only in-patient care, mainly at the tertiary level.

 

The 12th Five Year Plan and the NHM’s Framework for Implementation commit to undertake upto three UHC pilots in each state, which will pave the way for scaling up of Universal Health Coverage across the country. These pilots  need to be adequately funded and well planned with their performance measured against carefully selected and standardized indicators.


The team


Convened by the World Health Organization (Country Office) in India, 10 organizations including DFID, GIZ, ILO, UNAIDS, UNDP, UNFPA, UNICEF, USAID and the World Bank are working together to promote greater commitment to Universal Health Coverage in India

 

our goals


The United Nations in India is committed to supporting the Government of India in its progress towards Universal Health Coverage by providing evidence, technical and policy advice on effective interventions and the mechanisms to monitor progress.

 

event


Panel Discussion on Advancing Universal Health Coverage in IndiaAdvancing Universal Health Coverage in India: Lessons from International Experience

Professor Indrani Gupta, Institute of Economic Growth, Delhi, India; Dr Nata Menabde, WHO Representative to India; Ms Lise Grande, UN Resident Coordinator and experts from the World Health Organisation including Dr Vivian Lin, Dr Rüdiger Krech, Dr Alaka Singh and Dr Antonio Duran deliberated on India’s route to universal coverage and lessons to be learnt from countries in different regions of the world at a panel discussion organised by the United Nations in India on 8 May 2014.

 

Health Baithak

Health Baithak: Film Screening Fire in the Blood; Thursday, 29 May, 3pm, WHO India Country Office. The film ‘Fire in the Blood’, directed by Dylan Mohan Gray, highlights the life-saving role that the Indian generic drug industry has played in making anti-AIDS medicines available to millions of poor patients in Africa at a fraction of the cost charged by innovator brands.The film set a new all-time record for the longest theatrical run by any non-fiction feature film in Indian history following a five-week stint in Mumbai. The screening will be followed by a discussion.

 

 

 

 

 

Resources


BROCHURE

Brochure: Universal Health Coverage

 

Universal Health Coverage

The goal of Universal Health Coverage (UHC) is to ensure that all people obtain the health services they need without suffering financial hardship when paying for them. This requires a strong, efficient, well-regulated health system for providing the needed services, supported by availability of essential medicines and technologies; and a well-trained and motivated health workforce of sufficient capacity, all being appropriately financed, mainly by the government.

Opinion Editorials

Dr Nata Menabde

 

Advancing UHC in India: Learning from international experience
[Author: Dr Nata Menabde, Date: 11 June 2014, Source: Express Healthcare]
Dr Nata Menabde, WHO Representative to India enlightens on the measures that India can adopt to achieve Universal Health Coverage for its citizens and opines that much can be learnt from the efforts and experience of other nations in the same direction. 


Sustained effort required for universal health coverage
[Author: Dr Nata Menabde, Date: 26 May 2014, Source: Deccan Herald]
The director general of the World Health Organisation (WHO) Margaret Chan firmly believes that Universal Health Coverage (UHC) is ‘the single most powerful concept that public health has to offer.’

Fact Sheets

FactsheetsUniversal coverage ensures that all people can use health services without financial hardship

FactsheetsAll people should have access to the health services they need

Factsheets

Out-of-pocket payments push 100 million people into poverty every year


 


 

FactsheetsThe most effective way to provide universal coverage is to share the costs across the population

FactsheetsAll countries are continually seeking more funds for health care

FactsheetsIn 2010, 79 countries devoted less than 10% of government expenditure to health

 

 

 

FactsheetsCountries are finding innovative ways to raise revenue for health

FactsheetsOnly 8 of the world’s 49 poorest countries have any chance of financing basic services with their own domestic resources by 2015

FactsheetsGlobally, 20–40% of resources spent on health are wasted

 

 

 

FactsheetsBetter nutrition, particularly during pregnancy and lactation, is essential to women’s health

 

 

 

Photo Essays

Photo Essays: Achieving Universal Health Coverage

 

Achieving Universal Health Coverage

Key statistics from India’s health sector that indicate the need for universal health coverage.

Reports

The World Health Report - Health systems financing: the path to universal coverage

 

Health Systems Financing: A way to Universal Health Coverage 

In this report, WHO outlines how countries can modify their financing systems to move more quickly towards universal coverage and to sustain those achievements.  The report synthesizes new research and lessons learnt from experience into a set of  possible actions that countries at all stages of development can consider and adapt to their own needs. It suggests ways the international community can support efforts in low-income countries to achieve universal coverage.

Research for Universal Health Coverage 

Research for Universal Health Coverage 

Universal health coverage ensures everyone has access to the health services they need without suffering financial hardship as a result. In December 2012, a UN resolution was passed encouraging governments to move towards providing universal access to affordable and quality health care services. As countries move towards it, common challenges are emerging -- challenges to which research can help provide answers.

Monitoring Progress towards Universal Health Coverage at Country and Global Levels: A Framework- WHO-World Bank Dec 2013 

Monitoring Progress towards Universal Health Coverage at Country and Global Levels: A Framework- WHO-World Bank Dec 2013 

In recent years, there has been a growing movement across the globe for universal health coverage ensuring that everyone who needs health services is able to get them, without undue financial hardship.  This has led to a sharp increase in the demand for expertise, evidence, and measures of progress towards UHC and a push for UHC as one of the possible goals of the post-2015 development agenda. This discussion paper proposes a framework for tracking country progress towards UHC, assessing both the aggregate and equitable coverage of health services, as well as financial risk protection.

High Level Expert Group Report on Universal Health Coverage for India
 

Report of the High Level Expert Group on Universal health Coverage, Planning Commission of India 

The High Level Expert Group (HLEG) on Universal Health Coverage (UHC) was constituted by the planning Commission of India in October 2010, with the mandate of developing a framework for providing easily accessible and affordable health care to all Indians. The HLEG undertook a situational analysis of each of the key elements of the existing health system and has developed recommendations for reconfiguring and strengthening the health system to align it with the objectives of UHC, bridging the presently identified gaps and meeting the projected health needs of the people of India over the next decade.

Arguing for Universal Health Coverage 

Arguing for universal health coverage 

The handbook includes basic principles on health financing, country examples and evidence-based arguments to support Civil Society Organizations advocating for health funding policies that promote equity, efficiency and effectiveness, and ensure that the rights of the most vulnerable are not forgotten.

World Health Stats 2013

 

World Health Statistics 2013 

The World Health Statistics series is WHO’s annual compilation of health related data for its 194 Member States, and includes a summary of progress made towards achieving the health related Millennium Development Goals (MDGs) and associated targets. In 2013 it also includes highlight summaries on the topics of reducing the health gaps between the world’s most-advantaged and least-advantaged countries, and on current trends in official development assistance (ODA) for health.

WHO Global Health Expenditure Atlas

 

WHO Global Health Expenditure Atlas 

The 2011 WHO Global Health Expenditure Atlas presents health expenditure data from the 194 Member States of the Organization in individual country profiles and in individual country profiles and in regional and global summaries.  The GHED is updated annually and can be accessed at http://apps.who.int/nha/database/DataExplorerRegime.aspx

 

Videos

Dr. Nata Menabde, WHO Representative to India 

Catastrophic health expenditure 
Dr. Nata Menabde, WHO Representative to India, says that the number of people that have fallen into poverty because of catastrophic expenditure on health has risen in India over the last decade (1994-2004) in both rural and urban areas.

A.K. Shivakumar, Development Economist  

Financing universal healthcare
A.K. Shivakumar, Development Economist says India needs a strong public sector in health if it is to achieve universal health care. However the public sector remains grossly under funded. India needs to increase funding of the public sector in health through taxation; prioritize primary health care funding (allocate 70 percent of financing in this area) and give states more flexibility in spending health resource allocations as they see fit.

Anuradha Gupta, Additional Secretary and Mission Director, National Health Mission 

Achieving universal health coverage

Anuradha Gupta, Additional Secretary and Mission Director, National Health Mission, Government of India on government efforts to provide healthcare to all.

Dr. T. Sundararaman, National Convenor, Universal Health Coverage: Role of Civil Society 

Universal health coverage: Role of civil society
Dr. T. Sundararaman, National Convenor, Jan Swasthya Abhiyan (People’s Health Movement) says it’s important for the civil society to put pressure on the Government to increase public financing of health, and to provide actual, effective access to healthcare for all.

Dr. K. Srinath Reddy, President, Public Health Foundation of India 

Public financing of health
Dr. K. Srinath Reddy, President, Public Health Foundation of India says the country needs to increase public financing of health to more than 3 percent of GDP.

WHO: The many paths towards universal health coverage

 

WHO: The many paths towards universal health coverage 

This video, produced by the World Health Organization, explains the concept of universal coverage and uses examples from six countries - China, Oman, Mexico, Rwanda, Thailand and Turkey - to show ways that all countries can provide accessible and affordable care for their people.

 The Road to Universal Health Coverage 

The Road to universal health coverage 

WHO's report On the path to universal coverage takes evidence from all over the world to show how all countries, rich and poor, can adjust their health financing mechanisms so more people get the health care they need.

 

Voices from the Grassroots

Voices from Grassroots

  

Voices on Universal Health Coverage

The United Nations in India in partnership with World Comics India uses the power of comics to tell stories from across India, across communities, and across languages. Through workshops held in the country, young people, women, men and children who are poor and from marginalized communities find expression through comics. The collection of stories from common people are a reflection of the issues they face to access quality healthcare and medicines at affordable cost.

 

 

Information on Universal Health Coverage

What is Universal Health Coverage?
The goal of universal health coverage is to ensure that all people obtain the 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.

What does Universal Health Coverage actually mean?
The aims of Universal Health Coverage (UHC), as defined by the World Health Organization, are: “to provide all people with access to needed health services (including prevention, promotion, treatment and rehabilitation) of sufficient quality to be effective; and ensure that the use of these services does not expose the user to financial hardship.”

United Nations resolution on universal health coverage
Global support for universal health coverage is gathering momentum, with the unanimous adoption of a resolution in the United Nations General Assembly that emphasizes health as an essential element of international development. The resolution, adopted on 12 December 2012, urges governments to move towards providing all people with access to affordable, quality health-care services.

Questions and Answers on Universal Health Coverage and the post-2015 Framework
Universal health coverage (UHC) has a direct impact on a population’s health and welfare. Access to health services enables people to be more productive and active contributors to their families and communities. It also ensures that children can go to school and learn. At the same time, financial risk protection prevents people from being pushed into poverty when they have to pay for health services out of their own pockets. 

The Lancet Series- India towards Universal Health Coverage, 2011
In this themed issue of The Lancet, the first of three Series papers explores the evidence on the links between expansions in coverage and population health outcomes. The second paper looks at the political and economic dimensions of the transition to universal health coverage, and the third examines nine low-income and lower-middle-income countries in Africa and Asia that have implemented national health insurance reforms. Also, a Viewpoint calls for continued progress and argues for a large public sector role in health systems reform. What becomes clear in this issue is that although universal health coverage is not a guarantee for progress, attention should focus now not on whether, but on how to make the most of the transition.

Human Resources for Universal Health Coverage: Special Issue of Bulletin
Read editorials, news, reviews, perspective etc. on the special theme of human resources for universal health coverage.

Director General of WHO’s 2013 Convocation Address at the AIIMS
Read the Convocation Address by Dr Margaret Chan, Director-General of the World Health Organization, at the All India Institute of Medical Sciences in New Delhi, India on 12 September 2013.

World Bank Group President on Universal Health Coverage in Emerging Economies
Read the speech by the World Bank Group President Jim Yong Kim on Universal Health Coverage in Emerging Economies.

Thematic Guide: Universal health Coverage
Medicus Mundi International is a Network of organisations working in the field of international health cooperation and advocacy. Read their thematic guide on universal health coverage.

Universal Health Coverage Initiative for India
The Public Health Foundation of India (PHFI) was appointed Secretariat by the Planning Commission of India to provide technical and administrative support to the High Level Expert Group on Universal Health Coverage in preparation of this report.

Towards Universal Health Coverage
UHC Forward is an online platform that helps people interested in universal health coverage (UHC) keep track of what is happening in countries around the world by serving as a platform for sharing experiences and best practices. It also facilitates the exchange of knowledge. UHC Forward gives users access to hundreds of publications and reports, comparative case studies of country reform efforts, regular articles from global health experts that explore key issues and policy debates related to UHC and the opportunity to exchange ideas with others by submitting blogs or articles.

Health Systems
A good health system delivers quality services to all people, when and where they need them. The exact configuration of services varies from country to country, but in all cases requires a robust financing mechanism; a well-trained and adequately paid workforce; reliable information on which to base decisions and policies; well-maintained facilities and logistics to deliver quality medicines and technologies.

Health Financing
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.

 

News Articles


Quality health care with public funds
[Date: 11 June 2014, Source: The Hindu (op-ed)]


Empower community health workers with technology: Experts
[Date: 29 May 2014, Source: First Post]


Coming soon: Health cover for all, says Harsh Vardhan
[Date: 28 May 2014, Source: The Economic Times]


ALL NOT WELL IN HEALTHCARE!
[Date: 27 May 2017, Source: The Pioneer]


What the new govt can do to set the health system right
[Date: 26 May 2014, Source: Live Mint (op-ed)]


more>>

 

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