Health is the most important thing not just for an individual but for the entire world. Keeping everyone physically and mentally healthy is paramount and for that, health organizations dedicatedly work to promote health quotient around the world. The universal health coverage day is observed annually on 12th December to ensure global wellness. The theme for this year is ‘Leave no one’s health behind: invest in health systems for all’. Onlymyhealth spoke to Dr. Rakesh Kumar, Chief Advisor- Population Services International, India to know more about the need and importance of universal health coverage and what steps are being taken for the same on the country level. Scroll down as he shares his insights.
What is the purpose of Universal Health Coverage Day?
WHO definition of UHC is “all individuals and communities receive affordable, quality, and accessible health services they need without suffering financial hardship. It includes the full spectrum of essential, quality health services, from health promotion to prevention, treatment, rehabilitation, and palliative care across the life course.” It is also enshrined under the Sustainable Development Goal 3: to ensure health and wellbeing for all.
The Universal Health Coverage Day aims to advocate the importance of universal healthcare in society, bring in political accountability, and act for solidarity and equity. The UHC Day is a reminder to leaders and the global health community to accelerate the implementation of their commitments to achieve universal health coverage by 2030, develop and communicate clear pathways to achieve UHC, align health systems investments, using a primary health care approach, create space for meaningful social participation and value the involvement of non-state actors, identify and reach all groups in society at risk of being neglected (equity), ensure gender-equitable leadership and gender-responsive health systems and collaborate beyond the health sector on both universal health coverage and wider health determinants.
Also Read: 'Har Ghar Dastak': Government Starts Door To Door Covid-19 Vaccination Programme
Why establishing a health system is important in India?
To this question, Dr. Kumar answers, “Healthcare systems in India need to be made more robust and resilient to be able to provide healthcare services to all even amid any acute or chronic shocks such as the current COVID-19 pandemic. Cities have been gravely affected by these shocks and therefore, the need of the hour is to particularly focus on strengthening the urban health systems, linkages to broader social services, and organizing markets to serve the target populations. This will help in accelerating progress towards achieving UHC.”
- Strong primary health care systems can meet most people’s diverse health needs across a lifetime.
- Through the health systems approach every community can be supported by promoting healthy behaviors and routine check-ups, preventing disease and injuries, and providing and coordinating any curative, rehabilitative, and palliative care that people need.
- India has a very robust private health care sector; however, the focus of the private sector is more on secondary and tertiary care and hence the responsibility of primary health care falls on the public sector which needs to be revamped.
- Ayushman Bharat, Health and Wellness Centers program- is ensuring that comprehensive primary healthcare is made accessible and available to people near their homes free of cost. The second pillar of Ayushman Bharat digital mission ensures quality secondary and tertiary healthcare services from both public and private sectors free for the most vulnerable 40% population of India. The insurance coverage of 5 lakh rupees per family has helped significantly reduce our pocket expenditure and prevented many families from catastrophic healthcare expenditures.
How immunisation can help in bettering health services in peri urban areas?
As per NFHS-5 data, the routine immunization services for children and pregnant women have got a massive boost because of the Ministry of Health and Family Welfare’s Mission Indradhanush (MI) and Intensified MI routine immunization campaign. We must not lose this momentum, especially during pandemic times.
- Urban poor such as domestic workers, etc. are daily wage and migratory population. They can gain from flexible routine immunization session timings such as evening sessions or Sunday sessions where they can take their children or go themselves to the nearby Urban Primary Health Center (UPHC) to get vaccinated.
- The demarcation of catchment areas (microplanning) and allotment of catchment areas to ANMs,
- ASHA workers can help in reaching the urban poor. Solving governance issues such as convergence of inter-ministerial/ departmental of Maternal, and Child Health Department, and Women and Child
- Development for better coordination and implementation of schemes and policies and exploring the use of IT for tracking migratory populations can help in reaching the last mile.
Besides, learnings and best practices from India’s first adult immunization program on COVID-19 vaccination can lead the way for rolling out other adult immunization programs at a mass scale such as cervical cancer, influenza, meningitis, etc. in the future. These are challenging but exciting times for the immunization programs around the world.
What are the steps that need to be taken to safeguard maternal health in underprivileged women?
According to Dr. Kumar, “Institutional births have increased substantially from 79% to 89% at the all-India level, the fifth round of the National Family Health Survey shows. Many states have performed remarkably better with the percentage of institutional births of more than 90%. Less privileged women, especially those who live in peri-urban or hard-to-reach areas, can benefit immensely if maternal health services focus on attaining high Antenatal Care (ANC) coverage under Pradhan Mantri Surakshit Matritva Abhiyan. It can help in identifying high-risk pregnancies early on. Peri-urban and tribal areas continue to have access issues.:
“Proper road infrastructure and access to a public hospital or upgraded UPHC that can handle childbirth or complicated cases in peri-urban areas and hard-to-reach populations will help people access to care anytime. The Ministry of Health launched the "SUMAN" program last year i.e., Surakshit Matritva Abhiyan – an assured, dignified, and respectful delivery of quality healthcare services at no cost and zero tolerance for denial of services to any woman and newborn visiting a public health facility to end all preventable maternal and newborn deaths and morbidities and provide a positive birthing experience. This program is expected to improve maternal healthcare services significantly as it encompasses all existing schemes like PMSMA, LaQshya, JSSK, FRUs, etc., and a robust grievance redressal mechanism through help desk in facilities, a toll-free number - 1800-180-1104 or by registering on the online portal,” he added.
Can a decline in the total fertility rate improve the health system of our country?
Usually, mothers giving birth to more children (high Total Fertility Rate) are the ones who have been married at an early age. Child and adolescent marriages are often causes of early and frequent pregnancies where the spacing between two births has not been followed. This often leads to poor health of the women, newborns, children, and they are susceptible to a high burden of disease and mortality. Southern states have been able to arrest high TFR and therefore, are performing better on most reproductive, maternal, newborn, and child health indicators and have been able to provide quality services to people with equity at the center stage, without burdening of health systems.
To improve TFR, especially among urban poor women, the focus of government interventions should be on social determinants of health i.e., provision of better education to girls, better nutrition, focusing on equity and women empowerment, and improving their socio-economic status.
Also Read: World Population Day: Impact Of Coronavirus Crisis On Maternal Health
Health programmes in pipeline that aim to strengthen India's health sector
Two health programs have been announced by the Government of India which are critical to achieving universal health coverage.
Ayushman Bharat Digital Mission: It aims to bring the healthcare records of citizens onto a national digital platform. Each citizen will be issued with a unique 14-digit health identification number, which will also double up as their health account and contain details of every test, every disease, doctors visited, the medicines taken, and the diagnosis will be made available. It will be portable, enabling patients to access it even if they shift to another city.
PM Ayushman Bharat Health Infrastructure Mission: It aims to fill critical gaps in public health infrastructure, especially in critical care facilities and primary care, in both urban and rural areas. It aims to establish an IT-enabled disease surveillance system through a network of surveillance laboratories at block, district, regional and national levels. It will help in detecting, investigating, preventing, and combating public health emergencies and disease outbreaks.
Conclusion
Dr, Rakesh Kumar concluded by saying, health for all is a human right. Empowered populations can trigger health reforms in any country. Behavior change communications can help in driving health-seeking behavior which in turn can push demand for and availability of affordable, quality, and accessible universal healthcare services. More power to the people.
Image credits- freepik