(For UPSC / HPPSC / State Civil Services Aspirants)
UNIVERSAL HEALTHCARE: NEED OF THE HOUR
Kamala was a class-9 student living in the bastar region of the tribal hinterland of india. Her father made a livelihood by collecting tendu leaves and other minor forest produce from the nearby forest. Her life was going all fine until one day a catastrophe struck her.
Kamala’s father met with a terrible accident one day when he went to the forest to collect the tendu leaves. By the time he was taken to the district hospital, which was 150 kms, there was no life in his body.
Kamala’s life was never the same after the incident. She left her studies to help her mother in raising her 4 younger siblings. Kamala’s dream of becoming a doctor remained just a dream. Kamala’s story could have been different if there was a healthcare centre nearby, if the government ensured universal health coverage to all its citizens.
‘Universal health coverage’ (UHC) involves providing quality, affordable, accessible healthcare to all its citizens. To be a healthy and successful nation UHC is indispensable. Healthy nation is one where citizen’s physical and mental well being is ensured. A successful nation is one where people are happy and prosperous, the inequality levels are low and the country is self-reliant and helps other nations in need.
We will first see how UHC could ensure a healthy and successful nation.
Amartya Sen, in his book, ‘The Uncertain Glory’ argued the importance of UHC for the success of any nation. He substantiated his argument by giving the growth of China as an example. China which gained independence around the same time as India invested heavily in healthcare during the 1960’s and 1970’s to provide UHC. This increased life expectancy drastically and helped in building a healthy nation that could provide support in building an industrialised nation. That’s why today china is known as ‘the world’s factory’. Thus, China’s growth story is an example of how UHC leads a nation on the path of success.
Leaving the question of a nation’s success aside, the fundamental job of a nation is to protect its citizen’s lives. This protection does not only involve providing security from dangers such as terrorist attacks and disasters but also involves providing healthcare services to prevent avoidable death’s like Kamala’s father.
Moving forward, to build a successful nation, poverty alleviation, and reducing inequality are indispensable. Today, out-of-pocket expenditure accounts for more than 61%. This pushed families hovering around the Below poverty line into severe poverty. One unfortunate incident is enough to decide a family’s future prospects. India cannot expect itself to become a successful nation with such a situation prevailing at the ground level.
Moreover, healthcare needs are more for women, children and elderly whose healthcare needs are more often than not ignored. UHC could ensure healthy mothers, healthy mothers would ensure healthy children. Healthy children represent the future of our nation. Only when our children are healthy and our elderly have a dignified life in their last days can we think of India being a successful nation. Or else, incidents like in gorakhpur hospital where around 100 children lost their lives in a span of a month for non-availability of oxygen cylinders will repeat again.
Not only to prevent incidents like that at gorakhpur govt hospital, even to fight pandemics like COVID-19 requires the presence of UHC. A successful nation requires resilience to face pandemics or else, it will go back by 20 years in terms of its developmental progress as said by many economists and leaders worldwide.
Alternatively, healthcare also includes mental healthcare. Mental wellbeing is indispensable for being a healthy and successful nation. Until recently, mental health has been an ignored sphere. As argued by “yuval noah harari” in his book, ‘21 lessons for the 21st century’, to face the future where the world would witness unprecedented changes, a balanced mind which is free from anxiety, depression, and fear is indispensable. Thus, a UHC which includes mental health is necessary for India to become a healthy and successful nation.
Before venturing into what India needs to do to ensure UHC, we will first look at the present status of healthcare in India and the challenges it faces for ensuring a UHC.
Healthcare in India is a state subject. It is explicitly mentioned in our constitution in art-47 as the directive principle of state policy for the state to provide universal healthcare. Moreover, the Supreme Court in various judgements has included healthcare with the ambit of art-21, right to life.
India has increased life expectancy from around 32 years at time of independence to 70 years now. But, still Infant mortality rate and maternal mortality rate are quite high when compared to India’s neighbours like srilanka and bangladesh. around 50 % women are anaemic. And India has the world’s largest population of malnourished children. The present status makes it necessary for India to endorse UHC.
Also, there are many challenges to make UHC a reality. Firstly, the rural-urban divide in healthcare services is very stark. One-third of the population living in urban areas has two-third of healthcare providers. Thus, leading to a weak rural healthcare system. Also, the doctor-population ratio in India is around 1350/1 lakh population whiler WHO prescribes 1000/1 lakh population. Thirdly, government expenditure on healthcare is only 1.3% of GDP while other developing nations like Indonesia spend more than 3%.
To overcome the above challenges in healthcare, the government has taken initiatives like aayushman bharat for providing quality healthcare to poor, national health policy has mentioned increasing healthcare expenditure to 2.5% by 2025. Also, insurance schemes like Atal pension yojana for workers and pradhan mantri jeevan jyothi bima yojana for citizens have been launched.
Although the above measures are steps in the right direction, for making India a healthy and successful nation, following measures are necessary.
In the short term, incentives should be provided to doctors and hospitals to set up clinics and healthcare centers in rural areas. Tax benefits can be given. Secondly, India can replicate the success story of Bolsa familia in Brazil, where conditional cash transfers to the poor are provided if beneficiaries visit government hospitals for yearly health check-ups. Similar conditionality can be explored in the PM-Kisan scheme so that preventive healthcare systems are strengthened in india.
Thirdly, the healthcare budget needs to be raised to 2.5%. Finance commission can nudge states to increase healthcare expenditure by providing additional fund transfer on conditions of increasing healthcare expenditure.
In the long term, India should try replicating a universal health insurance scheme, similar to OBAMA CARE in the US. Also, steps to increase the number of healthcare institutions so that shortage of workforce can be addressed. Thirdly, India should strengthen its research and development architecture in biotechnology and healthcare diagnostics so that the nation can become self-reliant. Lastly, an amendment to the constitution to include healthcare as fundamental rights is much needed.
Implementing the above measures could make India become a healthy and successful nation where people like Kamala can hope to realize their dreams. After all, as Gandhi said, ‘the greatness of a nation is determined by how it treats its weakest members
By: Vishal Singh