Health for all an utopian dream

HEALTH FOR ALL,
An Utopian Dream or
Possible Reality –The Indian
Context
Dr Deodatt M Suryawanshi
Associate Professor
Community Medicine

Outline of Presentation
• What is Health For All?
• Global Commitments :UN Declaration 1978 and MDGs 2000 ,SDGs.
• Is investing in health beneficial.
• Is health a Priority?
• What's ailing India's Health care.
• Light at the Horizon: Universal health coverage (2012 -2022)

What is Health for All ?
• Universally recognised as means to achieve Economic
development
• Commitment to promote the advancement of all citizens to achieve a
higher quality of life
NHmFAU -National Health & Medical Facilities accrediation unit

HEALTH FOR ALL -HOLISTIC CONCEPT
Agriculture Industry
Education
Medicine & Public
Health
Health For All

Health for all : Universal Agreed Goal
UN Declaration in Alma Alta,
Kazakhstan 1978,the goal to achieve
Health for all by 2000 through
essential Primary Health care.

Primary health Care
• Primary healthcare (PHC) refers to
• "essential health care"
• based on scientifically sound and socially acceptable methods and technology,
• which make universal health care accessible to all individuals and families in a
community.
• through their full participation.
• at a cost that the community and the country can afford it.
• to maintain at every stage of their development.
• in the spirit of self-reliance and self-determination.

Millennium Development goals (2000 -2015)
• Reiteration of Commitment Of
Health for all through time bound
goals.
• 3 out of 8 Goals directly related to
Health

Constitution of India
• Article 21 : Right to Life and live with dignity.
• Directive principles of state policy.

Why investment in health is
beneficial

Feedbacks loops for the Development of nation

Education
Health
Human
Capital
Human
Development

Seizing the Demographic dividend

Seizing the demographic dividend…..
• India will have largest amount of workforce in the working age group by
2026.
• The challenge is to how to harness the vast potential of this human resource
and use in development of nation.
• Formation of human capital is essential for the development of the nation as
skillful and healthy workforce is an asset.

Healthy & Skilled work
Force
Contributing
more to the
GDP of the
nation
Economic
Development

Why health is not the
priority in India?

Maslow's hierarchy :Theory of Motivation of
Needs

• If Physiological needs of people are not satisfied
they will seldom consider other needs as a priority
• People in India today are still facing the following
Problems:
 Poverty
 Lack of Food security
 Affordable housing
 Access to safe water and Sanitation.

Monthly Per capita expenditure (MPCE)

Half of income is spent on Food

Lack of Food Security : Unsatisfied basic need
• Food Security : India ranks 100 out of 113 nations on
the Global Hunger Index (GHI) worse than
• Following facts presents a sorry picture of hungry India.
• 820 million chronically hungry people in the world.
• 1/3rd of the world’s hungry live in India.
• Over 20 crore Indians will sleep hungry tonight.
• 10 million people die every year of chronic hunger and hunger-
related diseases.

• > 70 yrs of Independence still we are the same starting point where we started
poor ,Hungry ,malnourished vulnerable to the Triple burden of diseases.

Decreasing order of Priorities

What's Ailing India's Health care

AVAILABILITY OF HEALTH CARE
• Availability of health care services:
 Public and private sectors taken together is quantitatively inadequate.
 Rural urban divide : 25 % 75% divide for Resources and infrastructure.
 Lack of Skilled human resources.

Quality of healthcare services
• Lack of Technical qualified Persons in Rural areas.
• Mercy of Quacks
• Regulatory standards for public and private hospitals are not adequately
defined and, in any case, are ineffectively enforced.

Affordability of health care
• Problem for the vast majority of the population, especially in tertiary care.
• Lack of extensive and adequately funded public health services.
• Out of pocket expenditures arise even in public sector hospitals, since lack of medicines
means that patients have to buy them.
• Lack of Universal Health insurance.

Prone to Diseases
Out of Pocket
spending
Selling of income
earning assetsPoverty
Lack of accessible and
affordable
Health care

Pattern of health financing
• The health care system in India pre–dominantly is catered to by the private sector
• Expenditure in the private sector contributes to 70.05% of total health expenditure,
• Public sector accounts for 21% and
• External flows 2.28%.
• In totality, Health expenditure formed 3.9 % of Gross Domestic Product (GDP)

3.9 % of GDP
spent on
Health
Govt spends
1.13% only
(ideal 5%)

Share of Health expenditure
(2005 to expected 2022)
959
(79%)
1825
(74%)
1725
(34%)
242
(21%)
675
(26%)
3450
(66%)
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
2004 to 2005 2011 to 2012 target 2022
YEARS
Public share2
Private share

International Comparison of Health Expenditure

Remedies
• 12 th Plan envisages to seize the
demographic dividend by investing in
Health of the people through the
concept of Universal health access or
Universal health coverage(UHC) for all
by 2022.

The Planning commission in Oct
2010 instituted a HLEG on
Universal Health coverage to give
inputs on universal health coverage
Under the Leadership of Dr K
Srinath Reddy .

What is Universal access to health ?
 Ensuring equitable access for all Indian citizens(irrespective of various distinctions)
 To provide affordable, accountable, appropriate health services of assured quality
(promotive, preventive, curative and rehabilitative)
 Addressing the wider determinants of health delivered to individuals and
populations.
 The government being the guarantor and enabler, although not necessarily the only
provider, of health and related services.

System Types:Single payer
• Single Payer: The government
provides insurance for all residents
(or citizens) and pays all health care
expenses except for co-pays and
coinsurance. Providers may be
public, private, or a combination of
both.
• Norway
• United Kingdom
• Kuwait
• Sweden
• Bahrain
• Brunei
• Canada

Two-Tier
• The government provides or
mandates catastrophic or minimum
insurance coverage for all residents
(or citizens).
• The citizens purchase additional
voluntary insurance or fee-for
service care when desired.
• New Zealand
• Netherlands
• Denmark
• Austria
• Ireland
• Hongkong
• singapore
• Israel

Insurance Mandate
• The government mandates that all
citizens purchase insurance,
whether from private, public, or
non-profit insurers.
• Greece
• US
• spain
• South korea
• Swizterland
• Germany
• Belgium

where the problem is

Why the need for Universal health Coverage
Increase Life
expectancy
Population
Vulnerable to non
communicable
diseases
Rising Cost of
Health expenditure
Health
Awareness
Increase
demand
Triple Burden
Of Diseases
Communicable
diseases
Non
Communicable
Mental illness

Vision of the HLEG on UHC

Recommendations of the HLEG
Health Financing and
Financial Protection
Human resource for health
Access to Medicines,
Vaccines and Technology
Management and
Institutional Reforms:
Community Participation
and Citizen Engagement.
Gender and Health

Health Financing and Financial Protection
 Increase public expenditure on health
from the current level of 1.2 per cent of
GDP to at least 2.5 per cent by the end of
the Twelfth Plan, and to at least 3 per cent
of GDP by 2022.
 Ensure availability of free essential
medicines by increasing public spending
on drug procurement.(0.1 to 0.5% of GDP)

Financing Health care For Universal Access
General taxation Comprehensive Health
insurance
RSBY

A National Health Package
should be developed that offers,
as part of the entitlement of
every citizen, essential health
services at different levels of the
healthcare delivery system.

Human Resources for Health:
• Institutes of Family Welfare should be strengthened
• Regional Faculty Development Centres should be selectively developed to enhance
the availability of adequately trained faculty and faculty-sharing across institutions.
• District Health Knowledge Institutes, a dedicated training system for Community
Health Workers.
• Establishment of National Council for Human Resources in Health (NCHRH)
should be established.

• Norms For Health Staff
2011 2017 2022
Allopathic doctors, nurses and midwives per
1000 population
1.29 1.93 2.53
Population served per allopathic doctor 1953 1731 1451
Ratio of nurses and midwives to an
allopathic doctor
1.53 2.33 2.94
Ratio of nurses to an allopathic doctor 1 1.81 2.22

Access to Medicines, Vaccines and Technology:
 Price controls and price regulation, especially on essential drugs, should be enforced.
 The Essential Drugs List should be revised and expanded, and rational use of drugs
ensured.
 Public sector should be strengthened to protect the capacity of domestic drug and
vaccines industry to meet national needs.
 Safeguards provided by Indian patents law and the TRIPS Agreement against the
country’s ability to produce essential drugs should be protected.
 MoHFW should be empowered to strengthen the drug regulatory system

Management and Institutional Reforms:
 Creation of All India and State level Public Health Service Cadres and a specialised
State level Health Systems Management Cadre.
 The establishment of a National Health Regulatory and Development Authority
(NHRDA) a, National Drug Regulatory and Development Authority (NDRDA) and
a, National Health Promotion and Protection Trust (NHPPT) is also recommended.

Community Participation and Citizen Engagement:
Existing Village Health Committees should be
transformed into participatory Health Councils.
Organise regular Health Assemblies
Institute a formal grievance redressal mechanism at the
block level.

Gender and Health:
Improve access to health services for women, girls and other
vulnerable genders (going beyond maternal and child health)

Expected outcomes of UHC

Conclusion
 Health can only be made a priority when Government satisfies physiological needs of people,
which will lead to more awareness and health seeking behavior among people.
 Health is a medium of Economic development and investing in Health is Beneficial for the
growth of a nation.
 Universal Health coverage envisaged by the Planning Commision is a welcome step in the
direction

Thank you

References
• National health accounts 2004-2005 report
• 12th plan outlay document
• India human development report 2011
• Report of high level expert group on Universal Health coverage in India.

Health for all an utopian dream

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