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How realistic are India’s universal health care plans?

What’s happening? The Lancet Citizens’ Commission has been launched in India, with the aim of developing a roadmap towards universal quality, affordable health care coverage. The “fragmented” nature of the country’s health system has been highlighted by the Covid-19 pandemic, said Vikram Patel of Harvard Medical School, one of the four leaders of the commission. The other three leaders are Kiran Mazumdar-Shaw of Biocon, Gagandeep Kang of the Christian Medical College in Vellore, and Tarun Khanna of Harvard Business School. The commission will consult with stakeholders in the country’s health system, including citizens, and aims to publish its findings by August 2022.

Why does this matter?  With a population of almost 1.4 billion people, India accounts for 17.7% of the world’s population. Despite this, government expenditure on health care is less than 1.3% of GDP, although there are plans to increase this to 2.5% by 2025. This lack of funding has led to a severe lack of hospital beds in the country. In rural areas, the situation is even worse – where health care is available, standards are drastically low, causing patients to die unnecessarily.

Social inequalities compound the issue even further. The Covid-19 pandemic has brought the Indian health care system to its knees and reveals it radically needs to change to serve the population efficiently, effectively and affordably. Social disparities have also seen the country have to tackle issues such as open defecation. The Clean India Mission, which was established to address the issue, estimated that, in 2014, only four in 10 rural Indian households had access to a toilet. The campaign had been established to build enough public toilets to end open defecation by 2019. The UN is looking to eliminate open defecation globally by 2030.

Although each state is obliged to provide free universal health care (UHC), chronic underfunding leaves many deficient in the services they can offer. The problem is exacerbated by a shortage of health professionals, particularly in rural areas. This often leaves people with no other choice than to seek treatment at private hospitals. The majority of the Indian population, however, don’t have health insurance and out-of-pocket private health care costs are high, pushing millions of people into poverty every year.

Previous efforts to implement UHC have failed to materialise, so the Lancet Citizens’ Commission project is both challenging and ambitious. In addition to engaging with stakeholders, it also aims to address health expenditure, governance and staffing along with how technologies can improve health outcomes and access to care.

It will be interesting to see how the commission will meet these challenges, for example, wealthy countries such as the US and the UK depend on foreign nurses for their own health care systems, which leaves poorer countries – including India – with a shortage. Will its planned roadmap ensure there are enough health care professionals to provide care for every citizen that needs it?

Perhaps the greatest opportunity presented by the commission is that alongside curative care, it also aims to focus on promotive and preventative care. Indeed, the population is taking notice of this and by driving it further, and making sure it reaches all levels of society, this will not only improve health but also decrease the burden on the health care system. This is potentially where corporates can step in and help their staff with robust wellness programmes to help them and their families take positive steps to improve and maintain their health.

Lateral thought from Curation – The use of technology to access health care may raise concerns for the population too. The Aadhaar system, which rolled out in 2009, requires biometrics to access government services. However, the technology is not perfect and has left some people without welfare payments for no apparent reason, thus plunging them into poverty.

Now, the government, in an effort of its own to take a step toward UHC, is planning a digital health ecosystem. This will give those who sign up, along with their doctors, electronic access to their health records via a unique ID. However, although this will be voluntary, this system will likely have to be linked to Aadhaar if users want to access public health care. If the technology fails, then the neediest patients could be left without treatment and, in turn, this could lead people to distrust any other official digital services offered.

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Nicola Watts

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