Universal health coverage a snapshot with focus on india
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The theme of the document is universal health coverage (UHC) with the slogan of "Health for All". It discusses India's progress towards achieving UHC by 2030, including increasing public spending on health and reducing out-of-pocket expenditures. It analyzes India's UHC index, noting coverage of essential health services and financial protection are below global medians. Recommendations include increasing government health expenditures, strengthening primary healthcare through programs like Ayushman Bharat, and ensuring access to medicines and qualified health workers across all states to progress toward UHC.
Universal health coverage a snapshot with focus on india
- 1. THEME OF WHD IS : UHC : EVERYONE, EVERYWHERE SLOGAN IS “# HEALTH FOR ALL” UHC BY 2030 One billion more people to get benefit from quality health services & financial protection by 2023 if we are to meet SDG target 3.8 on achieving UHC Name of the Speaker Dr.Rama shankar Assistant Professor !1
- 2. 12.12 UNIVERSAL HEALTH COVERAGE DAY !2
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- 4. ▸ Individuals ▸ Citizens ▸ Political Parties ▸ Parliamentary health committees !4 ▸ Government ▸ Professional Associations ▸ Civil Society ▸ The Media
- 5. DIMENSIONS OF UHC SERVICES: Which services are covered ( include other services) FINANCIAL PROTECTION: what do people have to pay out of pocket ( reduce cost sharing and fees) POPULATION: who is covered ( extend to non covered COVERAGE MECHANISM !5
- 6. DIMENSIONS OF UHC SERVICES: Which services are covered ( include other services) FINANCIAL PROTECTION: what do people have to pay out of pocket ( reduce cost sharing and fees) POPULATION: who is covered ( extend to non covered UHC ACHIEVED !6
- 7. A FRAMEWORK FOR UHC AS PART OF THE SDGS !7 Health System Strengthening Universal Health Coverage All people and communities receive the quality health services SDG1: No poverty SDG4: Quality education SDG5:Gender equality SDG16:Inclusive societies SDG 8: Inclusive economic growth and decent job SDG3: Equitable health outcomes and wellbeing. global public health security and resilient societies DETERMINANTSOFHEALTH ACTIONS SDG TARGET3.8 IMPACT ON SDGS
- 8. HEALTH SYSTEM CONTEXT & THE WHO “FIT” STRATEGIES Strengthening institutions Supporting Transformation UHC 8 Building foundations Health system development towards UHC
- 9. !9 Guiding principle of UHC Universality Financial protection Comprehensive care Community participation Accountability & transparency Protection of patient right Equity Putting people’s health in people hands Non exclusion & non discrimination
- 10. EXPECTED OUTCOME UNIVERSAL HEALTH COVERAGE Financial protection Greater equity Increased job Greater productivity Accountability Efficient, accountable & transparent health system Improved health outcomes !10
- 11. !11 SDG 3.8 UHCSDG 3.8.1 SDG 3.8.2
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- 13. COVERAGE OF ESSENTIAL HEALTH SERVICES REPRODUCTIVE MATERNAL NEWBORN & CHILD HEALTH 1.Family Planning (FP) 2.Antenatal care 4+ visits( ANC) 3.Child Immunisation ( DTP3) 4.Care seeking suspected pneumonia INFECTIOUS DISEASE CONTROL 1.TB effective treatment (TB) 2.HIV treatment (ART) 3.Insecticide-treated nets ((TN) 4.At least basic sanitation ( WASH) NCD 1.Normal Blood Pressure (BP) 2.Mean fasting plasma glucose (FPG) 3.Cervical cancer screening* 4.Tobacco non-smoking ( Tobacco) SERVICE CAPACITY & ACCESS 1.Hospital bed density 2.Health worker density 3.Access to essential medicines* 4.IHR core capacity index (IHR) RMNCH= (FP+ANC+DTP3+ Pneumonia)1/4 Infectious= (ART+TB+WASH+ITN)1/4 If high risk malaria Infectious= (ART+TB+WASH)1/3 If low risk malaria NCD= (BP+FPG+Tobacco)1/3 Capacity= ( Hospital+HWD+IHR)1/3 UHC SERVICE COVERAGE INDEX= ( RMNCH INFECTIOUS NCD CAPACITY)1/4 !13
- 14. UHC service Index RMNCH Infectious disease NCD Service capacity and Access !14
- 15. UNIVERSAL HEALTH COVERAGE IN INDIA HEALTH FOR ALL UHC means that all people have access to promotive, preventive, curative, and rehabilitative health services, of sufficient quality to be effective, without facing financial hardship. Addressing inequalities in health care is central to the UHC agenda 1.31 billion !15 Population 33% of the total Urban Population 68.3 years Life expectancy at birth UNIVERSAL HEALTH COVERAGE : EVERYONE EVERYWHERE 167/100,000 live birth MMR 39/1000 live birth (2017) Under 5-year mortality rate 57% of the total premature mortality Premature mortality due to 4 common NCDs
- 16. POTENTIAL PATH TO UHC IN INDIA CURRENT SITUATION MOST services are paid for by individual households through direct OOP payment INTERMEDIATE SITUATION where SOME services are provided free of charge to all the population UHC Where MOST of the services are provided free of charge to ALL the population !16
- 17. UHC Healthfinancing& protection Healthservicenorms Humanresourceofhealth Communityparticipation& citizenengagement Accesstomedicine& technology Managementand Institutionalreforms IT- enabled National Health Entitlement Card ( NHEC) !17
- 18. ▸ Govt ( Central & State) should increase public health expenditures on health from the current level of 1.2% of GDP to at least 2.5% by the end of the 12th plan and at least 3% of GDP by 2022. RECOMMENDATIONS: HEALTH FINANCING AND FINANCIAL PROTECTION Private spending Public spending RS 1825 RS 675 RS 1975 RS 1750 RS 3450 RS 1725 RS 2500 RS 3725 RS 5175 PROJECTED REAL PER CAPITA HEALTH SPENDING IN INDIA AT CURRENT PRICES (2009-2010) !18
- 19. !19 Private Spending Public Spending Projected share of public and private health spending in india Projected proportion of public and private out of pocket expenditures HEALTH FINANCING & PROTECTION
- 20. GOVERNMENT HEALTH FACILITIES 210 779 1022 5767 29698 156231Health Sub Centres Primary Health Centres Community Health Centres Sub district Hospitals/ Taluka Hospitals District Hospitals Medical College Hospitals 2.5% of CHC and 13.6% of PHCs are in Urban area UNIVERSAL HEALTH COVERAGE : EVERYONE EVERYWHERE!20
- 21. HEALTH SERVICE UTILISATION Private Sector Public Sector UNIVERSAL HEALTH COVERAGE : EVERYONE EVERYWHERE !21
- 22. UHC will be achieved when there is strong political will translated into sound policies and timely implementation •India has committed to achieve UHC as part of the SDG agenda. ★ State government has key role to play. Health is state subject as per constitution •National Health Policy 2017 is aligned to UHC principles of strengthening services delivery and ensuring financial protection UNIVERSAL HEALTH COVERAGE : EVERYONE EVERYWHERE !22
- 23. • Ayushman Bharat Program focuses on: ★ Comprehensive primary healthcare to be delivered through health and Wellness centres. ★Financial protection for secondary and tertiary level hospitalisations for vulnerable families ★Priority implementation in “Aspirational District” • All States have schemes to provide essential medicines free of cost in government health facilities • UHC requires the involvement of multiple stakeholders including civil society and private sector UNIVERSAL HEALTH COVERAGE : EVERYONE EVERYWHERE !23
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- 25. The out of pocket expenditure as a share of total health expenditure is 62.5% ( Middle income countries is 36%) Government health expenditure as a share of total government expenditure is 3.78% ( International expenditure is 10%) • There is wide variety in the availability of qualified health workers with vacancy rates for; ✦ Staff nurse ranging from 0 in Odisha to 75% in Jharkand ✦Medical officers at PHC ranging from 6% in Kerala to 64% in Bihar ✦Specialists at district hospitals, ranging from 0 to Nagaland to 89% in Arunachal Pradesh UNIVERSAL HEALTH COVERAGE : EVERYONE EVERYWHERE Progress towards UHC will be achieved when greater investments are made in health and when resources are used more efficiently !25
- 26. This is done by measuring (a) health service coverage and (b) financial protection so that those who are not getting health care and those who are being impoverished by it are identified and not left out UNIVERSAL HEALTH COVERAGE : EVERYONE EVERYWHERE !26
- 28. (A)UHC SERVICES COVERAGE INDEX • The index is a summary measure of 16 essential health services in 4 categories • Index for India is 54 and global median is 64 • 100 implies full coverage across a range of services Indicator India Median Globally Demand satisfied with modern method among women 15-49 years who are married or in union (%) 72 67 Antenatal care, four or more visits (%) 45 78 One year old children who have received 3 doses of DTP vaccine (%) 87 93 Care-seeking Behaviour for children with suspected pneumonia (%) 77 64 Reproductive Maternal Newborn and Child Health !28
- 29. Indicator India Median Globally People living with HIV receiving ART (%) 44 43 TB effective treatment coverage (%) 41 60 Population at risk sleeping under Insecticide treated bed nets (%) NA 59 Household with access to at least basic sanitation (%) 44 87 Infectious Diseases Indicator India Median Globally Age standardised prevalence of adults > 15 yrs not smoking tobacco in last 30 days (%) 88 78 Cervical cancer screening among women aged 30-49 years (%) N/A N/A Age standardised prevalence of normal blood pressure among children > 18 years, regardless of treatment status (%) 74 76 Age standardized mean fasting plasma glucose among adults > 25 years ( mMol/l) 5.6 5.5 NCD !29
- 30. Indicator India Median Globally Hospital beds per 10,000 population 7 21.6 Health worker density per 10,000 population 35.6 36.9 Proportion of health facilities with WHO core list of essential medicines available N/A N/A International Health Regulations core capacity index (%) 94 76 Service Capacity and Access (B) FINANCIAL PROTECTION Indicator India Median Globally %age of people who spend more than 10% of their household budget ( Total income or expenditure) paying for health care out of their own pocket 17.3 11.7 %age of people who spend more than 25% of their household budget ( Total income or expenditure) paying for health care out of their own pocket 3.9 2.6 %age of people incurring impoverishing OOP health expenses at the $1.90 poverty line 4.16 1.4 %age of people incurring impoverishing OOP health expenses at the $3.10 poverty line 4.61 1.8!30
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- 32. HEALTH & WELLNESS CENTRE NATIONAL HEALTH PROTECTION SCHEME AYUSHMAN BHARAT FOR A NEW INDIA-2022 !32
- 33. !33 ▸ NHP 2017 envisioned it as foundation of Indian Health system ▸ Rs 1200 crore allocated for 1.5 lakh health and wellness centre ▸ It shall provide comprehensive health care ( NCD and MCH services) ▸ Provision of free essential drugs and diagnostics services ▸ Contribution of Private sector through CSR and philanthropic institutions envisaged. HEALTH AND WELLNESS CENTRE
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- 36. THANK YOU ▸ “If we don’t create future the present extend itself” !36