|Year : 2019 | Volume
| Issue : 2 | Page : 92-96
Theme of World Health Day continued for the 2nd year in row (2018–2019) – What it means to India
Pushpa, Dewesh Kumar, Vidya Sagar, Vivek Kashyap, Anju Prabha Kumari
Department of Preventive and Social Medicine, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India
|Date of Submission||14-Sep-2019|
|Date of Decision||03-Oct-2019|
|Date of Acceptance||16-Oct-2019|
|Date of Web Publication||19-Dec-2019|
Department of Preventive and Social Medicine, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand
Source of Support: None, Conflict of Interest: None
Every year, the World Health Organization (WHO) celebrates World Health Day with a particular theme to aware the masses about the subject and focus on its relevance. For the past 2 years (2018–2019), the WHO has kept the theme same considering its prime importance in the contemporary world. The theme “Universal Health Coverage: Everyone Everywhere” is very pertinent for developing countries like India where universal access to adequate health care is a distant dream. Increasing health-care needs with high out-of-pocket expenditure is not allowing the public to move out of poverty. In contrast to continuous rise in the demand for health care, the supply side in India is not prepared to meet the challenges of complex determinants of health. In the past, there have been several interventions in the form of health insurance schemes with its own challenges of fragmentation of risk pools and no linkages with primary health care. Considering these challenges, the Government of India (GOI) has adopted a two-pronged strategy under the ambit of Ayushman Bharat Program. The first approach is upgrading primary health centers and subcenters to health and wellness centers and the second is the launch of Pradhan Mantri Jan Arogya Yojana. Through this program, GOI aims to achieve universal health coverage by 2022 which is achievable, but the challenges in reality are immense.
Keywords: Universal health care, Universal Health Coverage, World Health Day
|How to cite this article:|
Pushpa, Kumar D, Sagar V, Kashyap V, Kumari AP. Theme of World Health Day continued for the 2nd year in row (2018–2019) – What it means to India. Indian J Community Fam Med 2019;5:92-6
|How to cite this URL:|
Pushpa, Kumar D, Sagar V, Kashyap V, Kumari AP. Theme of World Health Day continued for the 2nd year in row (2018–2019) – What it means to India. Indian J Community Fam Med [serial online] 2019 [cited 2021 Apr 19];5:92-6. Available from: https://www.ijcfm.org/text.asp?2019/5/2/92/273530
| Introduction to World Health Day and Its Themes|| |
The World Health Organization (WHO) established on April 7, 1948, headquartered in Geneva, Switzerland, a member of the United Nations Development Group, is the organization which is concerned with international public health, having a 6-point agenda, consisting of 2 health objectives of promoting development and fostering health security, 2 strategic needs of strengthening health systems and harnessing research, and 2 operational approaches for enhancing partnerships and improving performance., Every year, World Health Day is celebrated on April 7 by various health institutions with a particular theme to draw the attention of people about the importance of that theme. Different kinds of activities such as debates, essay competitions, poster competitions, art exhibitions, quiz, and award ceremony are organized to fulfill the objective of World Health Day. The theme of World Health Day 2018 was Universal Health Coverage: Everyone Everywhere which is continued for 2019 also because of the fact that millions of people still do not have access at all to health care and millions are forced to choose between health care and other daily expenses such as food, clothing, and home. Universal health coverage (UHC) is an aspirational goal, which means that we all have desires and full hopes to achieve it certainly 1 day if we all try to make this dream come true. The dream of providing promotive, preventive, curative, and rehabilitative health interventions for each and every person at an affordable cost is all about achieving UHC, but it certainly does not mean free coverage for all possible health interventions, regardless of cost, as no country can provide all its services free of charge on a sustainable basis. Greater equity, improved health outcome, efficient accountable and transparent health system, reduction of poverty, greater productivity, increased opportunities for job, and financial protection are the expected outcomes from UHC.
The WHO uses 16 essential health services in four categories (reproductive, maternal, newborn, and child health; infectious diseases; noncommunicable diseases; and service capacity and access) as indicators of the level and equity of coverage in most countries of the world. These all are interrelated and are accessible only with the achievement of right to health. Right to health means health interventions which are of good quality, affordable, acceptable, appropriate and delivered timely. Three core dimensions of UHC proposed by the WHO are the proportion of a population covered by existing health-care systems, the range of health-care services available to a population, and the extent of financial risk protection available to local population., The vision of UHC for 2030 is universal health entitlement to each and every citizen, guaranteed access to an essential health package (including cashless inpatient and outpatient care), and freedom of people to choose between public and private sector facilities.
| Universal Health Coverage and Sustainable Development Goals|| |
One of the key features of the United Nations' Sustainable Development Goals is the progressive realization of UHC. India also has dreams of achieving UHC and has supported the theme of health for all since its independence which is evidenced by the reports of the Bhore Committee that had recommended a publicly financed national health service and a proper system for comprehensive preventive and curative care for all, long back in 1946. India is still committed toward achieving UHC, and its ambitions are clearly reflected in its health policies and institutional mechanisms, which are focused toward increasing coverage as well as access to health services. While announcing the budget for 2018–2019, the Union Finance Minister, Mr. Arun Jaitley, quoted “Only Swasth Bharat can be a Samriddha Bharat. India cannot realize its demographic dividend without its citizens being healthy and Ayushman Bharat Program will build a New India by 2022 and ensure enhanced productivity, well-being and avert wage loss and impoverishment.”
| Ayushman Bharat – a Step Toward Universal Health Coverage|| |
Ayushman Bharat Program (ABP), launched in India, is one of the most ambitious missions in order to achieve UHC, consisting of two schemes: (1) health and wellness centers (HWCs) and (2) National Health Protection Scheme (NHPS)/Pradhan Mantri Jan Arogya Yojana which are complementary to each other. HWCs are desired to provide comprehensive primary care including noncommunicable diseases and maternal and child health services, essential drugs free of cost, and diagnostic services, whereas NHPS is supposed to provide financial risk protection to poor and vulnerable families up to a maximum of 5 lakh rupees/family/year. The upgradation of 150,000 (of the existing 180,000) subhealth centers and primary health centers (PHCs) in India to HWCs by December 2022 is one of the two initiatives of ABP, along with an increase in the list of services provided through it. The aim is to make comprehensive primary health care accessible to the community within a short duration of 30 min of walking distance.,, The target is of making about 11,000 HWCs in financial year 2018–2019, and about 16,000 HWCs in the financial year 2019–2020, functional which also includes upgrading all 4000 PHCs in urban areas to HWCs by March 2020. The benefits of these HWCs will be available to 100% of population of our country when they are fully functional. The second initiative of ABP is NHPS which is the world's largest government-funded health-care (insurance) program. The previous program Rashtriya Swasthya Bima Yojana was providing Rs. 30,000 insurance coverage for up to 5 members of a family per annum, for a target beneficiary of about 60 million families. The target beneficiary in AB-NHPS has increased to about 107.4 million families considering its aim to target the beneficiaries beyond the traditional approach of “below poverty line” population. It includes “vulnerable and deprived population” which are identified through socioeconomic and caste census.
| Need of Universal Health Coverage in India|| |
The most important key in moving toward UHC is efficiency and priority setting to get the maximum value for the money spent. The need of health care is very unpredictable leading to out-of-pocket expenditures and wage loss as well in the poor and vulnerable families., The situation in India is so grave that around 50 million households fall in poverty annually due to out-of-pocket expenditures, which is mainly because of limited health-care facilities in public sectors. This forces patients toward private sectors along with the fact that our health-care system is dominated by a private sector, the share of private expenditure in total health expenditure is quite high as compared to the public expenditure, and there is a huge scarcity of public services in the public health sector., Outpatient care is also equally responsible along with hospitalization for the impoverishments of households. The families whose source of income is solely daily wages are the real sufferers as hospitalization causes loss of wages to more than one earning member of the family. Health insurances do not support for comorbidities and patient support services. AB-NHPS is meant to provide only secondary and tertiary inpatient care and not comprehensive outpatient care. Noncommunicable diseases, such as hypertension, diabetes, and mental illness, require long-term care and are best managed through comprehensive primary care in outpatient setting. Health schemes which favor only hospitalization over comprehensive outpatient care and coverage may not be appropriate for health needs of society. If the benefit package of the beneficiaries is designed such that their social, economic, and health-care needs are covered, such as provision of outpatient care, medicine and diagnostic charges, travel allowances, and compensation of wage loss, including special packages for elderly on long-term medication support, children with special needs, long-term rehabilitation services for people, and road traffic accident victims, then only it will lead to a complete health-care package. A health insurance covering financial risk protection will be fruitful to a patient only if it is readily accessible (if the health facility is not very far away) and with a favorable health outcome (trained health-care service providers are present).,,
| Strength Weakness Opportunity and Threat (Swot) Analysis of Ayushman Bharat|| |
Synergistic actions between AB-NHPM and HWCs will complement between secondary, tertiary, and primary health care and thus will help the common person to deal with the health issues in a more efficient way. India is still behind its neighboring countries Sri Lanka and Bangladesh in aspects of health outcome which is basically because of inadequate funding, lack of synergistic action between disease control and other social sector programs, poor regulatory mechanisms, and lack of good capacity in the management of health. There is a wide difference between rural and urban indicators of health. The 12th plan promotes the provision of safe and healthy environment to all, providing universal access to basic health services and medicines as well, and regular evaluation of health systems along with making the communities health conscious by various means such as communication, behavior change, and participatory governance. This will be possible only when trained health-care providers and technical health-care workers in adequate numbers are ensured for primary health care along with increase in human resource to achieve the WHO norms of having at least 23 health workers (doctors, nurses, and auxiliary nurse midwives)/10,000 population and by recruitment of adequate number of dentists, physiotherapists, pharmacists, technicians, and other health professionals at particular levels of health-care delivery systems where they are required. Hence, this scheme is an opportunity for Indian health system for providing better health care to masses.
India is having a long list of challenges to overcome which will be a hindrance in achieving UHC by 2022, such as very high disease burden, problems in reproductive and child health, malnutrition, gender inequality, lack of proper education, lack of trained human resource, especially in health, inadequate research works in the way to achieve health for all, commercial health-care delivery system, unequal access to health care, improper resource allocation, high out-of-pocket expenses on health, increase in geriatric population, and various other social determinants of health such as alcoholism, illiteracy, superstitions, poverty, and many more.,, To add to the list is a lack of political will, poor intersectoral coordination, and frequent natural disasters also.
This does not mean that the goal of UHC cannot be achieved in India. There is always a ray of hope when we look back to our history. Huge success of elimination of polio and eradication of smallpox and guinea worm despite the challenges proves that nothing is impossible if we all collectively try to achieve it. There are many such examples in the field of maternal and child health services too. Now, the maximum deliveries are institutional deliveries or at least conducted by trained birth attendants, even in hard-to-reach areas, which ensures proper care during delivery, lowering the risks of maternal mortality and increasing the prospective of child immunization also. Furthermore, they get financial support in the form of incentives, and the government ensures that there is no out-of-pocket expenditure for a pregnant female by providing her with all investigations during ante natal care and medicines free of costs along with free transportation by 108 ambulance/Mamta Wahan. The facility of free transportation has been extended to infants also. This is possible because of strengthening and investments on comprehensive primary health care. In India, we have great potential of human resources which can be trained at a low cost. They can represent the community and help in the development of health services also. A very good example of this potential human resource is the success of nearly one million accredited social health activists under the National Health Mission, who is a part of the community and serves their own people, proving the effectiveness of community health workers.,
| Way Forward|| |
Along with it, the role of representatives who are elected, Panchayati Raj institutions in rural areas, and local bodies in urban areas is very vital in achieving UHC as their political will and power can also help in bringing the desired changes in our country. This is because health is always underfunded due to its low ranking in the priority list of the political leadership. Higher budgetary demands for health by the Ministry of Health must be justified by evidence-driven investment case scenarios as too often in India, decisions about provision and priorities about health care are being made without any supporting evidence or evaluations of cost-effectiveness. Organization of health assemblies at regular intervals at different levels will enable the community to review about the health plans and about their performances also. Strengthening and utilization of civil society and nongovernmental organizations for mobilization of community and dissemination of information along with community-based monitoring of health services can play a pivotal role. Confidential complaints and grievances about health services can be tackled through development of a system of grievance mechanism at the block level which will improve the quality of health services at ground level. Along with financing and institutionalization, measuring the progress toward UHC is equally important. In a country like India, the practical and affordable solution for achieving UHC is only by strengthening of primary health care by increasing investments on comprehensive primary health care.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
World Health Organization. About WHO. Geneva: World Health Organization; 2019. Available from: https://www.who.int/about/en
. [Last accessed on 2019 Jun 09].
World Health Organization. Universal Health Coverage: Moving towards Better Health: Action Framework for the Western Pacific Region. Manila: WHO Regional Office for the Western Pacific; 2016. Available from: https://http://iris.wpro.who.int/handle/10665.1/13371.
[Last accessed on 2019 Jul 27].
World Health Organization. Monitoring Progress towards Universal Health Coverage at Country and Global Levels: Framework, Measures and Targets. Geneva: WHO and International Bank for Reconstruction and Development, the World Bank; 2014.
Rahman MM, Karan A, Rahman MS, Parsons A, Abe SK, Bilano V, et al
. Progress toward universal health coverage: A comparative analysis in 5 South Asian Countries. JAMA Intern Med 2017;177:1297-305.
Government of India. National Health Policy 2017. New Delhi: Ministry of Health and Family Welfare, Nirman Bhawan; 2017. p. 1-32.
Government of India. Report of the Task force on Primary Health Care in India. New Delhi: Ministry of Health and Family Welfare, Nirman Bhawan; 2017. p. 1-60.
Government of India. National Consultation on Ayushman Bharat: Operationalizing Health and Wellness Centres to deliver Comprehensive Primary Health Care. New Delhi: Government of India; 2018.
Government of India. Socioeconomic and Caste Census. New Delhi: Registrar General of Census Operations; 2012.
Singh Z. Universal health coverage for India by 2022: A utopia or reality? Indian J Community Med 2013;38:703.
Prinja S, Kaur M, Kumar R. Universal health insurance in India: Ensuring equity, efficiency, and quality. Indian J Community Med 2012;37:1429.
] [Full text]
Karan A, Selvaraj S, Mahal A. Moving to universal coverage? Trends in the burden of out-of-pocket payments for health care across social groups in India, 1999-2000 to 2011-12. PLoS One 2014;9:e105162.
Mackintosh M, Channon A, Karan A, Selvaraj S, Cavagnero E, Zhao H. What is the private sector? Understanding private provision in the health systems of low-income and middle-income countries. Lancet 2016;388:596-605.
Planning Commission. Report of the steering committee on health for the 12th
five year plan. Health Division Planning Commission; 2012. p. 5.
John TJ, Dandona L, Sharma VP, Kakkar M. Continuing challenge of infectious diseases in India. Lancet 2011;377:252-69.
Paul VK, Sachdev HS, Mavalankar D, Ramachandran P, Sankar MJ, Bhandari N, et al
. Reproductive health, and child health and nutrition in India: Meeting the challenge. Lancet 2011;377:332-49.
Rao M, Rao KD, Kumar AK, Chatterjee M, Sundararaman T. Human resources for health in India. Lancet 2011;377:587-98.
Government of India. National Health Mission. New Delhi: Ministry of Health and Family Welfare, Nirman Bhawan; 2005.