- Government should increase public on health from the current level of 1.2 per cent of GDP to at least 2.5 per cent by the end of the Twelfth Plan, and to at least 3 per cent of GDP by 2022 General taxation should be used as the principal source of healthcare financing not levying sector specific taxes. Specific purpose transfers should be introduced to on health across different states. primary health care should account for at least 70 per cent of all healthcare expenditure. The technical and other capacities developed by the Ministry as the core of UHC operations and 1. expenditure equalise the levels of per capita public spending Expenditures on of Labour for the RSBY should be leveraged transferred to the Ministry of Health and Family Welfare.
- Safeguards provided by Indian patents law and the TRIPS Agreement 2. on essential drugs, should be enforced. The Essential Drugs List should be against the country’s ability to produce essential drugs should be protected. MoHFW should be empowered to strengthen the drug regulatory system.
- Institutes of Family Welfare should be strengthened Regional Faculty Development Centres should be selectively developed to enhance the availability of adequately trained faculty and faculty-sharing across institutions.District Health Knowledge Institutes, a dedicated training system for Community Health Workers, State Health Science Universities and a National Council for Human Resources in Health (NCHRH) should be estalblished.
- 4.A National Health Package should be developed that offers,as part of the entitlement of every citizen, essential health services at different levels of the healthcare delivery system.
- All India and State level Public Health Service Cadres and a specialised State level Health Systems Management Cadre should be introduced in order to give greater attention to Public Health and also to strengthen the management of the UHC system. The establishment of a National Health Regulatory and Development Authority (NHRDA) a, National Drug Regulatory and Development Authority (NDRDA) and a National Health Promotion and Protection Trust (NHPPT) is also recommended.
- Existing Village Health Committees should be transformed into participatory Health Councils.
- There is a need to improve access to health services for women, girls and other vulnerable genders (going beyond maternal and child health).
Mode of Delivery of UHC
In our country, the present conditions include a large but severely under funded public sector, a growing but high cost private sector, with serious issues of inadequate quality and coverage in both, and an ineffective regulation. Based on this analysis and experience of different countries, both developed and developing countries a mix of both public and private systems has been suggested. In order to make this mix work, a strong regulatory framework is essential to ensure that the UHC programme is most effective in controlling cost, reducing provider induced demand, and ensuring quality. It could be supplemented by private service providers as well as Public Private Partnerships (PPPS).
There is also a need to build up institutions of citizens’ participation, in order to strengthen accountability and complement what the regulatory architecture seeks to do.
UHC must build on universal access to services that are determinants of health, such as safe drinking water and sanitation, wholesome nutrition, basic education, safe housing and hygienic environment. Therefore, it may be necessary to realise the goal of UHC in two parallel steps: the first, would be clinical services at different levels, defined in an Essential Health Package EHP), which the Government would finance and ensure provision through the public health system, supplemented by contracted-in private providers whenever required to fill in critical gaps; second the universal provision of high impact, preventive and public health interventions which the Government would universally provide within the 12th Five Year plan. The UHC would take 2-3 plan periods for realisation, but a move in terms of pilots and incremental coverage can begin in the 12th Plan itself.
Integrated primary, secondary and tertiary care has been envisaged in the Plan. The Primary Health Care will be strengthened to deliver both preventive, public health and curative clinical services. Publicly funded health care would predominantly be delivered by public providers. The primary health careproviders within the network will act as the gateway to secondary and tertiary care facilities in the network. Networks of such integrated facilities at different levels will be encouraged to provide a continuum of care, universally accessible and affordable services with the District Hospital as the nodal point. No fee of any kind would be levied on primary health care services with the primary source of financing being from general taxation/public exchequer.