Date: 21/03/2023

Relevance: GS-2: Issues Relating to the Development and Management of Social Sector/Services relating to Health, Education, Human Resources.

Key Phrases: International Conference on Primary Health Care, World Health Organization (WHO), World Health Assembly, Health for All by 2000, National Health Policy, Universal Health Care, Astana declaration.

Why in News?

• Health is a basic human right, guaranteed under the right to life in India's Constitution.
• However, achieving health in its wider definition requires addressing health determinants beyond medical and health departments.

Definition of health:

• The World Health Organization (WHO) defines health as a state of complete physical, mental, and social well-being, not merely the absence of disease or infirmity.
• This means that we cannot achieve health in its wider definition without addressing health determinants.
• This necessitates a need for an intersectoral convergence beyond medical and health departments such as women and child development, food and nutrition, agriculture and animal husbandry, civil supplies, rural water supply and sanitation, social welfare, tribal welfare, education, and forestry.

The Evolution of Universal Health Care:

• In 1977, the World Health Assembly endorsed the slogan "Health for All by 2000," implying universalization.
• Thus, nobody is denied this and everybody is eligible without being discriminated against on the basis of financial status, gender, race, place of residence, affordability to pay, or any other factors.
• India committed itself to this goal through its National Health Policy in 1983.

A focus on primary care

• The International Conference on Primary Health Care, at Alma Ata, 1978, listed eight components of minimum care for all citizens.
• It mandated all health promotion activities, and the prevention of diseases including vaccinations and treatment of minor illnesses and accidents to be free for all using government resources, especially for the poor.
• Any non-communicable disease, chronic disease including mental illnesses, and its investigations and treatment were almost excluded from primary health care.
• When it came to secondary and tertiary care, it was left to the individual to either seek it from a limited number of public hospitals or the private sector by paying from their own pockets.
• There were not enough government-run institutions for the poor (who cannot afford exploitative and expensive private care).
• This abdication of responsibility, i.e., to provide secondary or tertiary care by the state, ensuring the dominant, unregulated, profit-making private sector and also the health insurance sector was kept happy and thriving.
• This created a dichotomy between peripheral primary and institutional-referred specialist care at the secondary and tertiary levels.

Looking ahead:

• Comprehensive PHC:
  • Realising that even the poor contract chronic illnesses and non-communicable diseases such as cardiac, neural, mental, and metabolic disorders, and also require investigations and management at peripheral primary  health institutions, a Primary Health Care (PHC) Version 2 or Comprehensive PHC was defined.
  • It was operationalized through the National Rural Health Mission (NRHM) in India in 2013.
  • The second half of the last decade saw the operationalization of the Health and Wellness Centre as a model of implementation of Comprehensive Primary Health Care.
• Need for Comprehensive Universal Health Care:
  • Every individual has the right to be healed without complications, disability, or death.
  • The new global approach to UHC is individualism in public health, where nobody is left uncounted or uncared for.
  • The newer concept of UHC must encompass primary, secondary, and tertiary care for all who need it at an affordable cost without discrimination.

Flaws in the Universal Health Coverage Concept:

• Misleading Slogan:
  • Universal Health Coverage slogan is deceptive as it is not truly universal or comprehensive in its coverage of services.
  • Moreover, accessibility and affordability are not assured as financing is often conditional on insurance premiums.
• Pro-Market Driven Reforms:
  • World Health Organization's decision to yield to pro-market-driven reform guidelines during 2004-2010, which reduced state regulation and selectivity of uneconomical service coverages, dilutes the UHC concept.
• Out-of-Pocket Expenses:
  • While the World Health Assembly's resolution of 2011 urges countries to reduce out-of-pocket expenses and catastrophic expenditures in health, it falls short of addressing the issues of poverty and unemployment.

Astana declaration:

• Private Sector Partnership:
  • The Astana Declaration of 2018 calls for partnership with the private sector, despite the negative impact of industries such as alcohol, tobacco, ultra-processed foods, and pollution from commercial private sectors.
• Private Sector Regulation:
  • Poorer countries often fail or are unwilling to regulate the private sector, making the call for partnership with private sectors in the Astana Declaration impractical.
• Neglect of Broader Universal Health Care:
  • The Astana Declaration emphasizes quality Primary Health Care as the cornerstone for Universal Health Coverage but fails to address broader Universal Health Care issues such as poverty, unemployment, and poor livelihood.

Multi-nodal system:

• A globally accepted health systems concept since the Beijing Health Systems Research Conference 2012 is that of a multi-nodal system of varied sectors, professional streams, and specialties with various staff to deliver Comprehensive Universal Health Care.

Conclusion:

• India's National Health Mission, with concurrent intersectoral thrusts on Poshan Abhiyan, National Food Security, the Mahatma Gandhi National Rural Employment Guarantee Act, water sanitation, Sarva Shiksha Abhiyan, etc., is a better model of fully tax-funded Universal Health Care.
• Thus, moving forward with a newer concept of Universal Health Care is necessary to encompass primary, secondary, and tertiary care for all who need it at an affordable cost without discrimination.

Source: The Hindu

Mains Question:

Q. What is Universal Health Care, how has the Indian government's approach to health care evolved over the years, and what challenges remain in achieving Comprehensive Universal Health Care?