Azadi ka

Amrit-Mahotsav
Universal
Health
Coverage
Guided by- Dr. Amarnath Gupta Sir
Associate professor & HOD
Deptt. Of Community Medicine

Presented by- Dr. Dilip Wadbude

 “Health”
WHO
“Health is a state of complete physical, mental and
social well being not merely an absence of disease or
infirmity.”
• Recently amplified to include:
the ability to lead a socially and economically
productive life
 Primary Health Care

“Primary health care is essential health care made

universally accessible to individuals and acceptable to
them, through their full participation and at a cost the
community and country can afford.”
 Health For All

Attainment of a level of health that will enable every

individual to lead a socially and economically
productive life
 Historical Aspect:
• 1883- Health Insurance Bill, Germany became the first country to make nationwide
health insurance mandatory
• In U. K. Enactment of the National Insurance Act in 1911 and the National Health
Service (NHS) in 1948. which caters to all legal residents of Great Britain.
• Article 25.1 of the 1948 Universal Declaration of Human Rights states right to health as
an important fundamental right.
• 1966, The International Convention on Economic, Social and Cultural Rights
recognized "the right of everyone to the enjoyment of the highest attainable standard of
physical and mental health.
• 1978: Alma-Ata declaration & the vision of "health for all.“
• World Health Assembly adopted the term 'Universal Health Coverage' in 2005,
• India is embarking on an ambitious target of achieving Universal Health Coverage
for all during 12th Plan period.
• Everybody will be entitled for comprehensive health security in the country.
• It will be obligatory on the part of the State to provide adequate food, appropriate
medical care, safe drinking water, proper sanitation, education and health-related
information for good health.
• The State will be responsible or ensuring and guaranteeing UHC for its citizens.
HIGH LEVEL EXPERT GROUP (HLEG) ON
UNIVERSAL HEALTH COVERAGE (UHC)
• Constituted by the Planning Commission of India in October 2010

• Mandate: Developing a framework for providing easily accessible and affordable health

care to all India

• Assigned the task of reviewing the experience of India’s health sector and suggesting a

10-year strategy going forward

Why it is important in Indian context

• To attain Health For All.

• To reduce MMR 113/lac to 100/lac up to 2020.

• To reduce IMR 32/1000 to 28/1000.

• TB Eliminated up to 2025.

• Leprosy Eliminated up to 2018

• Number of bed 2 per 1000 population up to 2025.

UHC

• Ensuring equitable access for all Indian citizens, resident to any part
of the country, regardless of income level, social status, gender, caste,
or affordable, accountable, appropriate health services of assured
quality (preventive, curative and rehabilitative)
Objective

• Equity to access to health.

• To ensure good quality of health care services.

• Financial risk protection.

 GUIDING PRINCIPLES FOR UHC
6. Protection of patient’s rights
1. Universality
7. Consolidated and
2. Equity strengthened public health
3. Non exclusion and non provisioning
discrimination 8. Accountability and
4. Comprehensive care transparency
5. Financial protection 9. Community participation
10. Putting health in peoples
hand
Vision of UHC-2022

• Entitlement it is universal to every citizen.

• Nutritional health package it ensure access to all essential health

services including in-patient and out-patient care which is provided
free of cost.

• Choice of facilities: people can select public sector or contracted to

private sector.
EXPECTED OUTCOME OF UHC
Greater
Equity
Financial Improved
Health
Protection Outcomes

Efficient
Increased UHC Accountable
And
Jobs Transparent
Health System

Greater Reduction
Productivity Poverty
AREAS OF FOCUS TO FULFIL VISION

1. Health financing and financial protection

2. Health service norms

3. Human resource for health (HRH)

4. Community participation and citizen engagement

5. Access to medicines, vaccines and technology

6. Management and institutional reforms

1. Health financing and financial norms
• Increase public expenditure on health

• Increase public spending on drug procurement

• Rational prescription of quality generic drugs

• Use general taxation – principle of source

• Complemented by – mandatory deductions - proportion of taxable
income or proportion of salary
• Do not impose sector specific taxes
• Raise tax to GDP ratio - additional resources
• Widening of tax base

• Do not impose fees on any kind of health services

• Introduce specific purpose transfer from center

• Equitable per capita public spending
• Take away resistance to resource mobilization from center
• State has to contribute not substitute the funds from center
• Accept flexible and differential norms for allocating finances

• Expenditure on primary health care – >70% of health care expenditure

• Do not use independent agent to purchase health care services on behalf

of govt.

• All govt. funded insurance system – integrate with UHC

2. Health Service Norms
1 • VILLAGE LEVEL

• Develop a National Health Package

service at difference levels of 2 • SHC
delivery

3 • PHC

4 • CHC

• DISTRICT
5 HOSPITALS/MEDICAL
COLLEGES ETC.,
Village level:

• 2 CHWs, 1 AWW, 1 Volunteer

• Community health worker (CHW)
• Maternal and new born health
• Sexual and reproductive health and adolescent health
• Child health and nutrition for children, adolescent and women
• Communicable disease control and sanitation
• Chronic disease control
• Gender based violence prevention
Sub Center level
• One fully functional bed – observation and stabilizing pregnant women
• 1 BRHC, 2 ANM, 1 MHW, 1 Multitask worker
• Custodian of local untied funds
• Daily OPD service

PHC level
• First level access to Allopathic doctor
• Minimum 6 functional beds
• 24 electricity, telephone, internet connection, computers
CHC level
• 24*7 functional referral centers
• Emergency obstetric care
• Paediatric specialist care, sick newborn unit
• Surgical care, trauma care
• Well equipped lab
• AYUSH services
• >30 beds by 2017 and > 100 beds by 2025
District level
• Major center for health care delivery
• 90% of health care needs should met here
• Three pillars
• Clinical care
• Health human resource development
• Public health
• District health knowledge institute (DHKI)

• BRHC (Bachelor of Rural health Care) college

• Nursing school

• Training

• ANM, CHW, Staff Nurse, BRHC

• Develop effective contracting in guidelines – provision of health care by
private sector

• Government as purchaser and private sector as provider

• Reorient health care provision – focus on primary care

• Strengthen district hospitals

• Equitable access to functional beds – secondary and tertiary care

• Increase capacity to 2 beds per 1000 population by 2022

• Quality assurance at all levels of service delivery

• IPHS standard

• Creation of National Health and medical facility Accreditation Unit

(NHMFAU)

• Equitable access to health facilities in urban areas – focus on urban poor

3. Human Resource For Health

• Appropriately trained and supported practitioners and providers – close to

community

• Augment and strengthen the performance of professional and technical

health workers

• Ensure adequate number of health care providers

• 19/10,000 to WHO norm of 23/10,000 population

Continued..

• CHW – 1/1000 to 2/1000 pop ( 1- FM)

• BRHC

• Nursing staff – 90k to 1.7 mill by 2017 and 2.7 mill by 2025
• Nurse, Midwives : Doctor - 1.5 :1 to 3:1 by 2025

• Allopathy doctors – 0.5/1000 pop to 1/1000 pop by 2027

• AYUSH doctors – especially in allopathy doctor deficit areas

• Allied health professionals

• Enhance quality of HRH education and training – competency based health
system

• Invest in additional health institutions to produce and train health workers

• Establish district health knowledge institutes per 500,000 population/district

• Strengthen existing state and regional institutes of family welfare

• Develop regional faculty development centers
• Coordination of induction and in-service training
• Training system for CHWs – 3/team in DHKI – train 300 CHWs

• Establish state health service universities

• Establish the national council for human resources in health (NCHRH)

• Monitor and promote – standards of health professional education
 4. Community Participation And Citizen
Engagement
• Transform village health and sanitation committee – participatory health
council
• Existing members + civil society organization members + health
worker
• Every 6 month - evaluation
• Organize regular health assemblies
• Ground level experience assessment – changes

• Enhance role of elected persons as well as PRI in (RURAL) and local

bodies (URBAN)

• Strengthen the role of civil society and NGOs

• Institute a formal grievance redressal mechanism at block level

• Develop people facilitation center – provide information to local people
5. Access To Medicines, Vaccines And
Technology
• Enforce price control and regulations

• Revise and expand essential drug list

• Strengthen public sector to protect capacity of domestic drug and

vaccines industries to meet national needs

• Ensure rational use of drugs

• Setup national and state drug supply logistics corporations
• Procurement of cost effective generic essential drugs
• One ware house per district

• Protect safeguards provided by Indian patent law and TRIPs agreement

• Empower the ministry of health and family welfare to strengthen the drug
regulatory system
• Transfer the dept of pharmaceuticals from ministry of chemical and
fertilizers to MOHFW
 6. Management And Industrial Reforms
• MANAGERIAL REFORMS
• Introduce all India and state level public service cadres
• Public service cadre – public health service
• Management cadre – administrative responsibilitiesDevelop a National
Health Information Technology Network – uniform standards
• Electronic medical records
• Provide epidemiological database
• Track health expenditures
• Adopt better human resource practices to improve recruitment, retention,
motivation and performance
• Rationalize pay and incentives
• Assure career tracks

• Ensure strong linkages and synergies between management and regulatory

reforms

• Establish financial and budgeting systems to streamline fund flow

• Transparent performance based
INSTITUTIONAL REFORMS
• Establishment of following agencies
• National health regulatory and development authority(NHRDA)
• 3 units under NHRDA
• System support unit (SSU)
• National health and medical facilities accreditation unit
(NHMFAU)
• The health system evaluation unit (HSEU)
• National drug regulatory and development authority (NDRDA)

• National health promotion and protection trust (NHPPT)

• Invest in health sciences research and innovation to inform policy,

programme and to develop feasible solutions

 Challenges to implementing UHC IN INDIA
• The largest disease burden.
• Reproductive and child health problems, malnutrition.
• Issues of gender equality, poor availability of trained human resources in
health,
• Commercialized, fragmented, and unregulated health-care delivery systems
• Inequalities in access to health-care
• Imbalance in resource allocation, high out of pocket health expenditures
• Rising ageing population, social determinants of health such as poverty,
illiteracy, alcoholism etc.
• Lack of inter-sectoral co-ordination and political pull and push of different
forces and interests
Universal health coverage: 5 ways to get there faster

• Increasing health system resilience.

• Investing in subnational health systems.
• Digitalizing health systems.
• Prioritizing self-care.
• Focusing on people-centered care.
 Scheme of GOI to achive UHC
• Ayushman Bharat- PM-JAY.
• HWC FEBRUARY 2016
• CHO
• PRADHAN MANTRI JAN AROGYA YOJNA
• Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA)(9 June 2016).
• Pradhan Mantri Jan Aushadhi Yojna (October 2015).
• Pradhan Mantri Jan Dhan Yojna (20 August 2014).
• Pradhan Mantri Suraksha Bima Yojna (9 May 2015).
• Pradhan Mantri Jeevan Jyoti Bima Yojna (9 May 2015).
• Pradhan Mantri Swasthaya Suraksha Yojna (15 Aug 2003).
• Pradhan Mantri Matru Vandana Yojna (Pmmvy) (1st Jan 2017).
• Pradhan Mantra Sukanya Samriddhi Yojna (22nd Jan 2015).
• Beti Bachao Beti Padhao (22nd Jan 2015).
 A
Healthier world
is possible
•Thank you