Why India, a global leader in vaccination and immunisation, should now focus on Universal Health Coverage

India successfully administered more than one billion Covid-19 vaccinations, an outstanding milestone, considering its diversity and democratic nature. The Government of India successfully coordinated with the states for achieving this target in a transparent manner. Let’s also not forget that India is a global leader in immunisation coverage for children. Considering the same, the key emphasis now may be on reducing out-of-pocket expenditure on health through universal health coverage.

For analysing the immunisation coverage among children, the immunisation under consideration include Rotavirus vaccines completed dose (RotaC), Diphtheria tetanus toxoid and pertussis (DTP3), Measles-containing-vaccine first-dose (MCV1), Pneumococcal conjugate vaccines (PCV3), Hepatitis B (HepB3), Hib (Hib3), BCG, Polio (Pol3) immunisations coverage among one-year-olds and Measles-containing-vaccine second-dose (MCV2) immunisation coverage by the nationally recommended age.

The figure below reveals India’s status on immunisation coverage for the year 2018. In almost all immunisation programmes, the coverage is around 90 per cent with very low coverage (6 per cent) in the case of Pneumococcal conjugate vaccines (PCV3), and satisfactory coverage (35 per cent) in the case of Rotavirus vaccines completed dose (RotaC) immunisations coverage among one-year-olds. The common risk factors of pneumonia are malnutrition, non-exclusive breastfeeding for the first six months, low birth weight, and lack of measles immunisation, indoor air pollution and overcrowding. Thus the immunisation coverage may need to be further strengthened by India in these outliers. 

Child immunisation in India for the year 2018. Source: WHO

Out of Pocket expenditure on health

According to the World Health Organization (WHO), “Universal health coverage (UHC) is the single-most powerful concept that public health has to offer. It is the best way to cement the health gains made during the previous decade. It is a powerful social equaliser and the ultimate expression of fairness.”

Studies conducted across the world estimate that out-of-pocket payments push 100 million people into poverty every year. Globally, the average is 12.67 per cent which means that 12.67 per cent of the population spends more than 10 per cent of their income (out of their pocket) as health expenditure (WHO). The region which has this rate higher than this average includes South-East Asia (where India is included), which spends 16 per cent of their households’ income on health, as is evident in the figure below. 

Percentage of total population with out-of-pocket household expenditures on health greater than 10% and 25%. Source: WHO

For analysing the out-of-pocket household expenditures on health for India, the figure below represents the percentage of total population with household expenditures on health greater than 10 per cent and 25 per cent of total household expenditure or income in India in the year 2011, with the status of rural and urban population. As far as health expenditure above 10 per cent is concerned, 17.33 per cent of the population is spending out-of-pocket expenditure on health. If we consider the same in rural and urban areas, the percentage is high in rural areas compared to urban areas. With regard to expenditure on health greater than 25 per cent is concerned, 3.9 percentage of the population is spending out-of-pocket on health, with 4.34 percent in rural areas. Thus in India, UHC may need more focus in rural than urban areas as India’s rate is greater than the global average and even more than the South-East Asian average. 

 

 

The Goal of UHC is to ensure that all people obtain the health services they need without suffering financial hardship when paying for them. A strong, efficient, well-run health system that meets priority health needs through people-centred integrated care is achieved through informing and encouraging people to stay healthy and prevent illness; detecting health conditions early; having the capacity to treat disease; and helping patients with rehabilitation. The other aspect of UHC is affordability, wherein a system for financing health services where people do not suffer financial hardship when using them, can be achieved in a variety of ways. Access to essential medicines and technologies to diagnose and treat medical problems is another important aspect coupled with sufficient capacity of well-trained, motivated health workers, to provide the services to meet patients’ needs based on the best available evidence.

The 2019 Global Monitoring Report by the WHO gives a clear call for governments in all countries to invest an additional 1 per cent of their gross domestic product for primary healthcare. Sustainable health systems which promote universal access to care can be facilitated through the appropriate application of digital technologies. To deliver the best potential out of this, digital health ID has already been launched by India led by a robust strategy integrating human, financial, organisational and technological resources. India is also marching ahead with mammoth health coverage scheme called ‘Ayushman Bharat’ with tools such as Information and Communication Technology (ICT) and Aadhaar database and thus, the digital strategy achievement may not be much difficult. Online consultation through video conference for flu-like symptoms being a key part of such strategy helps during transmission of communicable diseases. Thus, there is a high possibility that India’s UHC may improve substantially in the days to come.

 Surjith Karthikeyan is an Indian Economic Service (2010) Officer; Athira Babu is an officer serving financial sector Regulator. Views expressed are personal.