Universal Health Coverage: India’s Journey vs. Global Goals (2025)

Universal Health Coverage (UHC) is a global aspiration, aiming to ensure that all people have access to needed health services without suffering financial hardship. India, with its vast population and diverse healthcare landscape, presents a unique case study in the pursuit of UHC. This post examines India’s progress towards UHC in the context of global benchmarks, focusing on key achievements, challenges, and future directions as we approach 2025.

What is Universal Health Coverage?

UHC encompasses three critical dimensions:

Breadth of Coverage: The proportion of the population that is covered by health services.
Depth of Coverage: The range of essential health services available.
Height of Coverage: The extent to which financial costs are covered, minimizing out-of-pocket expenditures.

The World Health Organization (WHO) and the United Nations (UN) have placed UHC at the heart of Sustainable Development Goal (SDG) 3: “Ensure healthy lives and promote well-being for all at all ages.”

India’s UHC Initiatives

India has undertaken several significant initiatives to advance UHC:

Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY): Launched in 2018, this is the world’s largest government-funded health insurance scheme, targeting over 500 million beneficiaries from the most vulnerable sections of society. It provides a health cover of INR 500,000 (approximately $6,800 USD) per family per year for secondary and tertiary care hospitalization.
National Health Mission (NHM): The NHM focuses on strengthening the public health system, particularly in rural areas, through improved infrastructure, human resources, and community participation.
Janani Shishu Suraksha Karyakram (JSSK): This scheme aims to reduce maternal and infant mortality by providing free and cashless services to pregnant women and newborns in public health facilities.

Progress and Achievements

India has made considerable strides in improving health outcomes:

Increased Health Coverage: AB-PMJAY has expanded health insurance coverage to a significant portion of the population, particularly those previously excluded.
Reduced Out-of-Pocket Expenditure: While out-of-pocket expenses remain a challenge, AB-PMJAY has contributed to reducing the financial burden on beneficiary families.
Improved Maternal and Child Health: Programs like NHM and JSSK have contributed to declines in maternal and infant mortality rates.

Challenges and Gaps

Despite progress, significant challenges remain:

Infrastructure Deficits: Many rural and remote areas lack adequate healthcare infrastructure, including hospitals, clinics, and diagnostic facilities.
Human Resource Shortages: There is a shortage of doctors, nurses, and other healthcare professionals, particularly in underserved areas.
Quality of Care: Ensuring consistent quality of care across all healthcare facilities remains a challenge.
Low Public Health Spending: India’s public health spending as a percentage of GDP is relatively low compared to other countries.
Data and Monitoring: Robust data collection and monitoring systems are needed to track progress and identify gaps in coverage.

India vs. Global UHC Goals

How does India’s UHC journey compare to global goals?

SDG Indicator 3.8.1: Coverage of essential health services. India has made progress, but disparities persist across states and socio-economic groups.
SDG Indicator 3.8.2: Proportion of population with large household expenditure on health. India needs to further reduce out-of-pocket expenses to align with global targets.

While India has implemented ambitious programs, achieving UHC requires sustained efforts to address systemic challenges and ensure equitable access to quality healthcare services for all.

Future Directions

To accelerate progress towards UHC, India needs to focus on the following:

Increased Public Investment: Increasing public health spending to at least 2.5% of GDP, as recommended by the National Health Policy.
Strengthening Primary Healthcare: Investing in primary healthcare centers to provide comprehensive and preventive care at the community level.
Digital Health Transformation: Leveraging digital technologies to improve access to healthcare, enhance data collection, and promote telemedicine.
Public-Private Partnerships: Fostering strategic partnerships between the public and private sectors to expand healthcare infrastructure and service delivery.
Capacity Building: Investing in training and development of healthcare professionals to address human resource shortages.

Conclusion

India’s journey towards Universal Health Coverage is a complex and ongoing process. While significant progress has been made through initiatives like AB-PMJAY and NHM, substantial challenges remain in terms of infrastructure, human resources, and quality of care. As India moves towards 2025, a renewed focus on increased public investment, strengthened primary healthcare, digital transformation, and strategic partnerships will be crucial to achieving the goal of UHC and ensuring that all citizens have access to affordable and quality healthcare services.