Universal Health Coverage.pptx

Current Scenerio in Universal health coverage in India

1. Current scenario and Significance towards achieving Universal Health Coverage DR. Sanjay Kumar Prof. and Head Department of community Medicine, IGIMS, Patna

2. Framework Universal health coverage Objectives Dimension Evolution in world and Indian context Current Scenario Myths about UHC Vision for UHC : HLEG Expected outcome The New Architecture For UHC: Way Forward

3. WHO theme for 2018 & 2019 Universal Health Coverage: Everyone, Everywhere

4. What is UHC? All individuals and communities receive the health services they need without suffering financial hardship Includes full spectrum of essential, quality health services, from health promotion to prevention, treatment, rehabilitation and palliative care

5. Objectives : Universal Health Coverage Equity in access to health services Quality of health services Financial-risk protection

6. Why Universal Health Coverage? Historical background: Alma Ata Declaration of 1978 2005-12: all nations have made the commitment to achieve universal health coverage "everyone should have access to the health services they need without risk of financial ruin or impoverishment" a powerful mechanism for achieving better health and well-being, and for promoting human development.

7. Global Momentum for UHC MDG 2000 UHC and the Millennium Development Goals (MDGs) are strictly connected. UHC implies open access for all to health services,& involves strengthening efforts to improve the quality, availability & affordability of services linked to the current MDGs including, for example, the fight against HIV/AIDS, TB, malaria & child and maternal mortality. Mental illnesses and injuries.

8. Global Momentum for UHC 2. Post- 2015 Development Agenda Sustainable Development Goal ( SDG) 3 “ Ensure healthy lives and promote well being for all at all ages” SDG Target 3.8 “ Achieve UHC, including financial risk protection access to quality essential health care services and access to safe, effective, quality and affordable essential medicines and vaccines for all”

9. Making progress towards UHC is a policy priority for both countries and global institutions Highlighted by the agenda of the UN Sustainable Development Goals (SDGs) adopted in 2015, reaffirming high-level political commitment to UHC and outlining a number of necessary actions in 2019 and WHO’s Thirteenth General Programme of Work ( GPW13 ),2025 target (1billion more people benefit from UHC, while also contributing to the 2 other billion targets of 1billion more people better protected from health emergencies and 1 billion more people enjoying better health and well-being.)

10. In 2018, Global Conference on Primary Health Care, 40 years after the adoption of the historic Declaration of Alma-Ata. came together to recommit to primary health care as the cornerstone of UHC in Declaration of Asthana . The Declaration aims to renew political commitment to primary health care from governments, non-governmental organizations, professional organizations, academia and global health and development organizations.

11. In 2020, the second UHC Forum, aiming to enhance political momentum on UHC in international fora. Twelve co-signatories including the WBG also launched the Global Action Plan for Healthy Lives and Well-being for All (GAP) to jointly support countries in delivering on the SDG3 targets. Some of WHO’s partnerships for support to advance UHC include: UHC2030 Alliance for Health Policy and Systems Research P4H Social Health Protection Network UHC Partnership Primary Health-Care Performance Initiative

12. UHC emphasizes not only what services are covered, but also How they are funded, managed, and delivered Investments in quality primary health care will be the cornerstone for achieving UHC around the world. Achieving UHC requires multiple approaches. The primary health care approach and life course approaches are critical

13. Tracking UHC UHC monitoring done by WHO and the World Bank developed UHC monitoring framework, Based on a series of country case studies technical reviews Consultations and discussions with country representatives Technical experts and Global health and development partners .

14. The framework focuses on the key components of UHC: Coverage of the population with quality , (affordable, quality health particularly to women, children, adolescents and people affected by mental health issues) Essential health services prevention (services for health promotion and illness prevention) and treatment ( treatment per se, but also rehabilitation and palliative care services) and Coverage of the population with financial protection.( incidence of impoverishment resulting from OOP health payments, and the incidence of financial catastrophe from the same cause. )

15. BACKGROUND - INDIA First concrete step: - During planning process of 12 th Five Year Plan: widely termed as Health Plan Planning commission constituted a High Level Expert Group on UHC 2010 Mandate: Developing a framework for providing easily accessible and affordable health care to all Indians HLEG also recommended Appropriate Health Care Financing as key strategy to achieve UHC

16. To address the policy challenges and fill critical gaps in achieving UHC, the National Health Policy (NHP)-2017 had been approved by the Union Cabinet. To translate its vision of the NHP-2017 into reality, the Government of India has approved Centrally Sponsored Ayushman Bharat-National Health Protection Mission (AB-NHPM)

17. Schemes to Promote UHC in India National Health Mission Janani Suraksha Yojana The Rashtriya Swasthya Bima Yojna The Jan Aushadhi Programme

18. Universal Health Coverage Global Index Source : Lozano, Rafael & Fullman, Nancy & Mumford, John & Knight, Megan & Barthelemy, Celine & Cristiana, Abbafati & Abbastabar, Hedayat & Abd-Allah, Foad & Abdollahi, Mohammad & Abedi, Aidin & Abolhassani, Hassan & Eshete, Akine & Guimarães Abreu, Lucas & Abrigo, Michael & Haimed, Abdulaziz & I. Abushouk, Abdelrahman & Adabi, Maryam & Oyabeda, Ijemidalo & Adekanmbi, Victor & Murray, Christopher. (2020). Measuring universal health coverage based on an index of effective coverage of health services in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. The Lancet. 396. 1250-1284. 10.1016/S0140-6736(20)30750-9.

19. Source : Lozano, Rafael & Fullman, Nancy & Mumford, John & Knight, Megan & Barthelemy, Celine & Cristiana, Abbafati & Abbastabar, Hedayat & Abd-Allah, Foad & Abdollahi, Mohammad & Abedi, Aidin & Abolhassani, Hassan & Eshete, Akine & Guimarães Abreu, Lucas & Abrigo, Michael & Haimed, Abdulaziz & I. Abushouk, Abdelrahman & Adabi, Maryam & Oyabeda, Ijemidalo & Adekanmbi, Victor & Murray, Christopher. (2020). Measuring universal health coverage based on an index of effective coverage of health services in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. The Lancet. 396. 1250-1284. 10.1016/S0140-6736(20)30750-9.

20. Current Scenario 2017 UHC Global Monitoring Report According to this report, much remains to be done to achieve UHC: At least half of the world’s population does not have access to quality essential services to protect and promote health 800 million people spending 10% of their household budget on out-of-pocket health care expenses Nearly 100 million people being pushed into extreme poverty each year due to health care costs

21. Grey areas Primary health services are a fundamental element of UHC, yet research warns that, if current trends continue, up to 5 billion people will still be unable to access health care in 2030. Maternal and child mortality remain high in several parts of the world, more than a fourth of girls and women in Sub-Saharan Africa cannot access family planning services, fueling unplanned pregnancies and maternal, infant and child mortality and morbidity. World Bank report showing that people in developing countries spend half a trillion dollars annually — over $80 per person — out of their own pockets to access health services, hit the poor the hardest and threatening decades-long progress on health.

22. World Bank/World Health Organization (WHO) research from 2019 shows countries must increase spending on primary health care by at least 1% of their gross domestic product (GDP) to close coverage gaps and meet the health targets under the SDGs. A lack of universal access to quality, affordable health services endangers countries’ long-term economic prospects and makes them more vulnerable to pandemic risks.

23. Why Is Moving Towards UHC Important? HEALTH BENEFITS Better access to necessary care & improved population health, with the largest gains accruing to poorer people ECONOMIC BENEFITS POLITICAL BENEFITS

24. Importance of Universal Health Coverage

25. Think BOLDLY & STRENGTHEN Financing for UHC

26. Financial risk protection is patchy Where out-of-pocket expenditure is high in relation to total health expenditure; 150M people suffer catastrophic expenditure each year Source: WHO

27. Dispelling Myths about UHC To be successful - Not just financing, should cover all components of health system Not only about assuring a minimum package of health services Its not about just health.......Its a step towards...... EQUITY, DEVELOPING PRIORITIES, SOCIAL INCLUSION & COHESION

28. Vision for UHC : HLEG Universal Health Coverage by 2022: The Vision ENTITLEMENT Universal Health entitlement to every citizen CHOICE OF FACILITIES People free to choose between Public sector facilities Contracted-in private providers NATIONAL HEALTH PACKAGE Guaranteed access to an essential health package (including cashless in-patient & out-patient care provided free-of-cost) Primary care Secondary care Tertiary care

29. THE NEW ARCHITECTURE FOR UHC: 6 CRITICAL AREAS: Health Financing and Financing Protection Health Service Norms Human Resources for Health Community Participation and Citizen Engagement Access to Medicines, Vaccines and Technology Management and Institutional Reforms

30. 1. Health Financing and Financing Protection Health financing is concerned with how financial resources are generated, allocated and used in health systems Health financing policy focuses on how to move closer to universal coverage with issues related to: how and from where to raise sufficient funds for health; how to overcome financial barriers that exclude many poor from accessing health services; or how to provide an equitable and efficient mix of health services

31. Health Financing and Financing Protection (Contd..) Present Indian scenario Recommendations by HLEG 1. The Government spending on 1. Increase public expenditures on healthcare in India is only 1.04% of health from the current level of GDP GDP which is about 4 % of total Government to at least 2.5% by the end of 12th expenditure, less than 30% of total plan (2012-17) and to at least 3% of health spending GDP by 2022. 2. JSY (2005) 2. Use general taxation as the principal source of health care financing 3. Chiranjeevi yojna (2006) 4. Rastriya Swasthya Bima Yojna (2008)

32. Rastriya Swasthya Bima Yojna (2008) • (Launched in 2007) by the Ministry of Labour & Employment • Cashless coverage of all health services • Smart-card-based system • Only hospital admission and day-care • Total of INR30000 insured per family below poverty line per year • Pre-existing illnesses also covered • Reasonable expenses for before and after hospital admission for 1 day before and 5 days after

33. Rastriya Swasthya Bima Yojna (2008) (Contd..) • Transport allowance (actual with limit of INR100 per visit) subject to a yearly limit of INR1000 • Only BPL Family • Up to five members for 1 year • renewal yearly • registration fee for a family is INR 30 • Central government contribution 75% & State government 25% of the premium

34. 2. Health Service Norms Present Indian scenario Recommendations by HLEG 1. Indian Public health Standard 1. Develop a National Health (IPHS) norms prevailing among Package the different levels of heath 2. Lot of emphasis on facilities. primary health care  3. IT-enabled National Health Entitlement Card (NHET)

35. 3. Human Resources for Health Present Indian scenario Recommendations by HLEG 1. India is facing a crisis in human 1. Increasing the number of trained  resources for health health care providers for  2. 2.2 million health workers which providing primary health care roughly translates to a density of 2. District Health Knowledge 22 health/10,000 Institutes (DHKIs) 3. ASHA 3.  National Council for Human Resources 4. AYUSH in Health (NCHRH) to prescribe, 5. Health workers are unevenly monitor and promote standards of distributed between the rural and health professional education. urban areas, and across states

36. 4. Community Participation and Citizen Engagement Present Indian scenario Recommendations by HLEG 1. Village Health, Nutrition and 1. In order to improve community Sanitation Committee (VHNSC) participation, it recommended 2. Rogi Kalyan Samiti (RKS)  transforming existing VHNSC into participatory Health Councils 2. The Health Councils should organize annual Health Assemblies at different levels (district, state, and nation) to enable community review of health plans and their performance as well as record ground level experiences that call for corrective responses at the systemic level.  

37. 5. Access to Medicines, Vaccines and Technology Present Indian scenario Recommendations by HLEG 1. There were 376 medicines 1. Revise and expand the essential  listed in NLEM 2015 drugs list 2. Jan Aushadhi programme (2008)  2. Enforce price regulation especially  on essential drugs 3. MCTS 3. Ensure rational use of drugs

38. 6. Management and Institutional Reforms (Recommendations by HELG)  Introduce All India and state level Public Health Service Cadres and a specialized state level Health Systems Management Cadre in order to give greater attention to public health and also strengthen the management of the UHC system (managerial reforms) Among Institutional reforms, it recommended the establishment of the National Health Regulatory and Development Authority (NHRDA) with three key units.: 1. System Support unit (SSU) 2. National Health and Medical Facilities Accreditation Unit (NHMFAU) 3. Health System Evaluation Unit (HSEU)

39. EXPECTED OUTCOME FROM UHC

40. Envisioning the Future: Seeking Stability & Health Protection in the Midst of Multiple Transitions Demographic transition Epidemiological & Nutritional Transitions Managerial Transitions Political Transitions Federal Nature of India’s Policy In conceptualizing a UHC system, a focus on India’s future will be crucial to ensure the implemented system is able to exist in, make the best of and respond to the country’s changing demographic, health, political and economic scenario

41. Way forward Strengthen regulatory framework and institutions (such as Insurance Regulator and Development Authority and Competition Commission of India) Synergy between AB-NHPM and Health and Wellness Centres

42. The growth of research… for universal health coverage

43. Thank you