Worldwide: Half The World Lacks Access To Essential Health Services: A Report By World Bank And WHO

On December 13, 2017, the World Bank and World Health Organization (WHO) released the Universal Health Coverage (UHC): 2017 Global Monitoring Report; simultaneously published in Lancet Global Health, suggests that half of the world lacks access to essential health services.

The Universal Health Coverage (UHC) says health services for all, which means everyone can obtain the health services they need without suffering financial hardship. However, the UHC report looks at how many people globally lack access to essential health services and how many are pushed into poverty or spending too much of their household budgets on health care expenses. Further, the calculation of universal health coverage service index is accomplished on the basis of national levels of coverage of 16 indicators, which are broadly categorized under four major groups as described in the flow chart given below –

IHR=International health regulations

Fig 1 – 16 indicators in four major groups

The UHC 2017 Global Monitoring report advocates that, more than 7.3 billion, though having access to some of health services, do not receive all of the essential services they need. In terms of financial protection, 800 million people spend at least 10 percent of their household budgets on health expenses for themselves, a sick child or another family member. For almost 100 million people these expenses are high enough to push them into extreme poverty, forcing them to survive on just $1.90 or less a day. But the report also shows some good news; the 21st century has seen an increase in the number of people able to obtain some key health services. In addition, fewer people are now being tipped into extreme poverty than at the turn of the century.

However, progress is highly uneven as there are wide gaps in the availability of basic healthcare services in SubSaharan Africa and Southern Asia. In some other regions with slightly better services as in Eastern Asia, Latin America and Europe, a growing number of people are spending at least 10 percent of their household budgets on out-of-pocket health expenses1.

Overall many countries are making progress towards UHC. Countries can take actions to move more rapidly towards it, or to maintain the gains they have already made. In countries where health services have traditionally been accessible and affordable, governments are finding it increasingly difficult to respond to the ever-growing health needs of the populations and the increasing costs of health services2.

Universal Health Coverage Forum 2017: Tokyo Declaration on Universal Health Coverage Adopted

The Japan International Cooperation Agency (JICA) co-hosted the Forum with the World Bank; the World Health Organization (WHO); the United Nations Children's Fund (UNICEF); UHC2030*1; the Ministry of Finance, the Ministry of Foreign Affairs; and the Ministry of Health, Labour and Welfare of Japan. High-level government officials from various countries, representatives of international agencies and experts — including the Japanese Prime Minister and the United Nations'Secretary General— gathered together and adopted the Tokyo Declaration on Universal Health Coverage, a commitment to achieve universal health coverage (UHC) by 2030. As an outcome of the Forum, the Tokyo Declaration on Universal Health Coverage was adopted. Pillars of the declaration as a commitment to achievement of UHC by 2030 include strengthening global momentum, accelerating countryled process and innovation3.

India and Universal Health Coverage (UHC)

In India, the Government has taken concrete steps to reduce the Out of Pocket Expenditure (OOPE) to achieve UHC, wherein some of the health programs and missions listed below play a major role-

  1. Mission Indradhanush/intensified mission indradhanush is one of the largest global public health initiatives launched in 2014. In its four phases till date, MI has successfully reached over 25 million children in over 528 districts.
  2. The Pradhan Mantri Dialysis Program has been launched under the National Health Mission (NHM) provided to States/UTs for provision of free dialysis services to the poor, where 1.43 lakhs patients have availed free services from 1,069 Dialysis units and under Free Drugs and Diagnostics Program.
  3. Affordable Medicine and Reliable Implants for Treatment (AMRIT) is a pharmacy outlets programme, where nearly 47 Lakh patients have benefitted from AMRIT Pharmacies through purchase of subsidized medicines. A total of more than 5000 drugs and other consumables are being sold at up to 50% discounts.
  4. Health and Wellness Centres (HWCs) is the plan, as per the Ministry, to transform 1.5 lakh Sub-health Centres to Health and Wellness Centres (HWCs) to expand the basket of services of primary care and make it comprehensive.
  5. National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS) is the Government initiated universal screening of common NCDs programme to provide free diagnostic facilities and free drugs for NCD patients attending the NCD clinics at the District and CHC levels. In FY 2017-18, over 1.92 crore people had been screened till the 2nd Quarter.
  6. Online Registration System (ORS) is a framework to link various hospitals for online registration, payment of fees and appointment, online diagnostic reports, online enquiry for availability of blood etc. As on date, around 124 hospitals including Central hospitals like AIIMS, RML Hospital; SIC, Safdarjung Hospital; NIMHANS; Agartala Government Medical College; JIPMER etc. are on board ORS.
  7. National Vector Borne Disease Control Programme (NVBDCP) was launched to control and eliminate Malaria, Japanese encephalitis (JE) and kala-azar.
  8. Labour Room Quality Improvement Initiative (LaQshya): There is enough evidence that supports the fact that improving the quality of care in Labour rooms is central to maternal and neonatal survival. LaQshya is expected to improve the quality of care that is being provided to the pregnant mother in the Labour Room and Maternity Operation Theatres, thereby preventing the undesirable adverse outcomes associated with childbirth.
  9. Operational Guidelines for Obstetric High Dependency Units (HDUs) and Intensive Care Units (ICUs) is another important aspect related to maternal mortality is availability of critical care for complicated cases. For this, the Government of India had released Guidelines for setting up of Obstetric High Dependency Units (HDUs) and Intensive Care Units (ICUs) in 2016.
  10. Safe Delivery Application: The Safe Delivery Application is a mHealth tool that can be used for health workers who manage normal and complicated deliveries in the peripheral areas. The application has Clinical Instruction films on key obstetric procedures which can help the health workers translate their learnt skills into practice4.

Conclusion -

The goal of achieving universal health coverage is the main focus of health system reforms around the world. In this view, the Government of India, to achieve Universal health coverage has recently increased the budget of the Health Ministry for 2017-18 up to 27.7%, and is planning to launch new improvised health programs to achieve UHC target.

Footnotes

1 http://www.who.int/mediacentre/news/releases/2017/half-lacks-access/en/

2 http://www.who.int/mediacentre/factsheets/fs395/en/

3 http://www.who.int/universal_health_coverage/tokyo-decleration-uhc.pdf

4 http://pib.nic.in/newsite/erelease.aspx?relid=174239

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