India needs to reorganise its healthcare system: WHO

Kolkata, Feb 22: India should reorganise its healthcare delivery system with the right mix and distribution of services to achieve Universal Health Coverage, a top WHO official has said.

Besides reducing out-of-pocket (OOP) expenditure incurred by people, government should also increase public expenditure on health and develop mechanisms for cashless access to health services at all delivery points', the official stressed.

"There are a few steps which can be taken by the Indian government to achieve UHC. Primarily it must reorganise the health service delivery with a right mix and distribution of preventive, promotive, curative, diagnostic and rehabilitative services to tackle comorbidities with higher access and availability of quality health services, developing effective referral linkage and ensuring continuity of care, from primary to tertiary care facilities," WHO representative to India Dr Nata Menabde told PTI.

"Additionally, there is a need for strengthened regulatory mechanism to oversee quality of health service provision, in both public and private sector," she said, adding governments must adopt new laws and regulations to implement health system reforms required for UHC.

Strengthening of human resources for health both in quantitative terms as well as performance and facilitating increased participation of communities through institutional and management reforms for ensuring accountability, transparency and responsiveness of the health system to the citizens would also be required, she stressed.

"There is need to engage private health sector in a policy dialogue around UHC planning, as well as delivery of services under the Universal Health Assurance (UHA) mission through defined mechanisms, to progress towards UHC in India," Menabde said.

Praising the role of the newly-elected government at the Centre on providing UHA, which includes the core components of UHC, she said, "Currently available information indicates that the proposed National Health Assurance Mission (NHAM) will include all key components to accelerate the progress towards UHC.

Simultaneously, India is drafting a National Health Policy focusing upon key aspects of UHC.

"There is a growing attention on looking at suitable models for financing of health services in India, along with development of next national health accounts for the country. These are the right planning steps for moving towards UHC in India," she said.

India, however, would require to develop a detailed scheme for planning and implementing its UHC vision where both public and privately provided service delivery units would have a role to play towards shared objectives, Menabde said.

On whether bringing the huge population of the country under the UHC would be feasible or not, she said, "The intention to move towards UHC need not to be affected by the size of the population. It is a journey to assure improved health outcomes to the entire population over period of time.

"We must remember that no country (except China) has ever taken on such a complex endeavour at such massive scale. It's known and well recognised (as in India's 12th Five Year Plan) that the pursuit of UHC will last for at least two to three plan periods (10–15 years) requiring strategies to go beyond any script in any one plan.

Therefore, attention needs to be paid by policy makers to identifying priority issues, key implementation challenges and main barriers," she said. They must focus on customising solutions across all health system functions — financing, service delivery, generation of resources (health workforce, medicines, technologies etc) and stewardship), she added.

Menabde said the next thing would be the implementation which must be accompanied by evaluation and analysis. "The state-level experiences and good practices needs to be documented and widely disseminated, including to other states. Importantly, in parallel, India needs to carefully design the institutional/organisational arrangements for the implementation.

The tools, management of partnerships, access to up-to-date health analysis, for informed decision making also need to be crafted," she said. The WHO official praised the provision of free medicines in some states in the country as the "right step" for other countries to emulate.

Menabde said the WHO has been involved in a high-level policy dialogue with the Centre on UHC-related issues, along with providing ongoing technical inputs.

Additionally, WHO India has direct engagement with a few states on advancing the UHC agenda and supporting them, in their initiatives in states like Kerala, Tamil Nadu, Gujarat, Tripura, Haryana and Rajasthan, she said.

The UHC entails that all people have access to required health services of sufficient quality while also ensuring that people do not suffer financial hardship for these services.

PTI