KOCHI: Universal health coverage is a system in which the general public receive health care without incurring any financial burden. Globally, many have expressed concerns about the need for such an initiative which can take care of the health needs and reduce poverty to a great extent. In fact, the concept of universal health coverage has been called the third global health transition that follows a demographic and epidemiological transition.
Spreading out the costs of illness across the population can ensure the poor pay less during illness, sparing them catastrophic expenditure and saving them from the claws of poverty.
The countries which have achieved UHC have responded to domestic pressures to control the cost of health care and moved from individual funding to pooled health care funding. Extensive government involvement in the financing, regulation and direct provision of health care services has been done in these countries.
Governments have to become the dominant force in expanding the pooled share of health spending through taxes or by rolling out insurance schemes. The different approaches to assess UHC can include financial protection through enrolment in health insurance, utilisation of health care and measuring it as a right. Many countries have guaranteed rights in their constitution of access to health care.
Primary health care systems
Comprehensive health care comprises promotive, preventive, curative, rehabilitative and palliative care services, the bulk of which can be delivered through primary health centres. Therefore, strengthening health care systems at the primary level to deliver quality care is the need of the hour. An under-resourced health budget with the least priority for primary care systems is the norm. The Health and Wellness Centres (HWC) of the government under the Ayushman Bharat scheme and the transformation of primary health centres into family health centres (FHC) in Kerala are a welcome change in the right direction. The HWCs are meant to provide palliative care for an expanded range of services. This will enable the common man/woman to benefit through a lifecycle or continuum of care approach. The Aardram Mission in Kerala is aimed at creating a people-friendly health delivery system.
Role of NGOs
The non-profit organisations have a role at the interphase of the people and health systems to raise awareness and provide basic health care services such as maternal and child health. They can also play a role in health service provision after being empanelled as a service provider under the scheme.
Dr Ashwathy S is a professor at the Department of Community Medicine, Amrita Hospital, Kochi. With inputs from Dr Vijayakumar, HOD, Department of Community Medicine. (The views expressed by the author are her own.)