How to achieve universal health coverage across India

Several ophthalmology institutions in South India connect village and town eyecare workers with research centres in hospitals

In the book Mission Possible by Swami Subramanian and Aparajithan Srivathsan (Notion Press, Chennai), they suggest ways to pave the road to Universal Health Coverage. It is a positive book that suggests paving the way to universal health coverage, with particular focus on India, which has a population of 143 crores (of which children account for 38% and senior citizens 11%). To offer universal health coverage to these people is no easy task, and the authors suggest ways to achieve this. 

Thanks to the advances in modern methods of analysis, using information technology appears doable, as the article “Reimagining India’s Health System” from The Lancet pointed out. This effort needs to be spearheaded by leaders from academia, scientific community, civil society, and private healthcare. The Public Health Foundation of India had proposed the creation of an Integrated National Health System in India through provision of universal health insurance, establishment of autonomous organisations to enable accountable and evidence-based good-quality health-care practices and development of appropriately trained human resources, the restructuring of health governance to make it coordinated and decentralised, and legislation of health entitlement for all Indian people.

Improving quality

This involves strengthening the public health system as the primary provider of promotive, preventive, and curative health services in India, to improve quality and reduce the expenditure on health care through the integration of the private sector within the national health-care system. In fact, the Bhore Committee report of 1946 (when the modern electronic communication system was unavailable) laid the foundations for India’s public health system. It recommended establishing a three-tier health care system that emphasised integrating preventive and curative services and ensuring access to medical care regardless of ability to pay. It also suggested major changes in the medical education system.

The book Mission Possible points out that just as Aadhar cards are used for personal identification and voter identifications used in elections, healthcare is best delivered by teams of health care workers using modern information technology methods. The team involves a local physician who is supported by a group of ‘community health workers’ who can do almost 75% of what the doctor can do (except in emergencies) and use tools such as mobile phones and electronic medical records of patients. As the authors state, ‘Technology is the glue that binds a team’. The team consists of community health workers all the way up to the specialist in a hospital. Each community health worker caters to a population of about 40,000 people and should work with a 75-bed district hospital which provides specialised tertiary care. Each State should have a world-class medical facility (e.g., AIIMS, Delhi; NIMS, Hyderabad). All MBBS (and MSc biotech) students should have three months training in community medicine.

The authors further suggest that an Indian Medical Service should be created, mirroring the role of the IAS in district administration. Those with advanced certification (MD) can cater to a whole State. Further, private medical centres and foundations should be allowed to coexist and offer modern quality healthcare. Indeed, several ophthalmology institutions in South India are already doing this, using a pyramidal four-tier model, connecting the village and town eyecare workers with the world-class eye research centres in hospitals; here, the patient does not even go to an eye hospital for diagnosis, the latter watches the patient’s eye at home through advanced technology methods. Thus, the road to universal health coverage can be paved.