(It
is time to evolve a social security system wherein every citizen could have access to the essential healthcare services they
need without any risk of financial ruin or impoverishment)
Entire world of a middle class man gets
shattered into shreds and pieces once he or his close kin is diagnosed of a
serious affliction like some rare form of cancer, chronic kidney failure or
tuberculosis and he is left with no other choice but to pull out all his
lifetime savings or sell some of his valuable assets like land or jewelry to
bear spine-breaking expenses to the tune of several hundreds of thousands of
rupees, on account of his dreadful disease. Even upper middle class people find
it catastrophic and devastating to pay the hefty medical bills after getting
themselves treated at the corporate hospitals outside the valley. Therefore health is not just about diagnosing
ailments, making hospital admissions and providing treatments, it is an issue
of social justice, social solidarity and social security too. Getting good
health care is not a privilege, it is considered to be a fundamental human right.
A just, humane and civilized society must be able to provide basic health
access to all its citizens irrespective of their social status or paying
capacity.
Universal health coverage (UHC) is the
aspiration that all people obtain the health services they need without having
to pay all costs out-of-pocket and without suffering any financial hardships
paying for them. Universal Health Coverage implies that all people have access,
without any discrimination, to the needed promotive, preventive, curative,
palliative and rehabilitative basic health services and essential, safe,
affordable, effective and quality medicines, while ensuring that the use of
these services does not expose the users to financial hardships, with a special
emphasis on the poor, vulnerable and marginalized segments of the population.
UHC ensures that the out-of-pocket expenditures by patients on their healthcare
are minimized and they are covered by adequate health insurance covers by the
government for which citizens have to pay a very little amount on annual basis.
It is a social security scheme in essence.
Globally,
about 150 million people suffer financial catastrophe annually while 100
million are pushed below the poverty line. Only
one in five people in the world has broad-based social security protection that
also includes cover for lost wages in the event of illness, and more than half
the world’s population lacks any type of formal social protection, according to
the International Labour Organization. Due to out-of-pocket spending of their
income on medicines and healthcare services, about 3.2 percent of India’s
population is pushed below the poverty line every year, as per published reports.
When poor households lack access to affordable medicines, they have to forego
treatment, sell precious assets, or make difficult choices between paying for
medicines and other basic necessities like food, clothing and children’s
education.
Promoting and protecting health is
essential for human welfare as well as sustained economic and social
development. This has been recognized almost 40 years ago by the Alma-Ata
Declaration signatories, who noted that ‘Health for All’ would contribute both
to a better quality of life as also to global peace and security. Recognizing this, member states of the World
Health Organization (WHO) committed in 2005 to develop their health financing
systems so that all people have access to services and do not suffer financial catastrophes
paying for them. WHO celebrates December 12th every year as the International
Universal Health Coverage Day and has published three annual world health
reports in the years 2003, 2010 and 2013 on the theme of Universal Health
Coverage. However UHC cannot be achieved, except for a small minority of the
population, without a well-functioning health financing system that determines
whether people can afford to use health services whenever they need them. Government alone cannot bear all
the expenditures on account of health insurance cover of its people.
Households, employers, insurance companies, NGOs and individuals need to
contribute their bit through minimal payroll taxes for this purpose. If all the
affluent people make small contributions annually, that can pave way for social
security of all particularly the poor.
The path to
universal coverage involves important policy choices and inevitable trade-offs.
All funds for health and medical care need to be pooled at one place for this
purpose. The way those pooled funds – which can come from a variety of sources,
such as general government budgets, compulsory insurance contributions (payroll
taxes), and household or employer prepayments for voluntary health insurance -
are organized, used and allocated, influences greatly the direction and
progress of reforms towards universal coverage. Pooled funds can be used to
extend coverage to those individuals who previously were not covered, to
services that previously were not covered or to reduce the out-of-pocket
payments needed for each service. These dimensions of coverage reflect a set of
policy choices about benefits and their rationing that are among the critical
decisions facing countries in their reform of health financing systems towards UHC.
The health
sector in Jammu and Kashmir is beset by many challenges in spite of the
considerable progress it has made of late in terms of extension, service
coverage and augmentation of manpower. A combination of weak institutional
capacity, limited access to modern equipment and infrastructure and shortage of
healthcare personnel has limited the effectiveness of health service delivery
in J&K. The healthcare system in J&K is primarily run by the local government
while private sector plays only a minor role in health service delivery and the
non-governmental sector is largely absent. Compared to the doctor-patient
ratio of 1:2000 in India, as against WHO recommendation of 1:1000, J&K has
one allopathic doctor for 3866 people, as per Central Board of Health
Intelligence, New Delhi. However, with the establishment of five new medical
colleges and two AIIMS in J&K this scenario is likely to improve in future.
For J&K
to achieve Universal Health Coverage for its 125 lakh population we need to
cross three major milestones viz., raising sufficient resources for health; removing
financial risks and barriers to access; promoting efficiency and eliminating
waste. To get closer to universal coverage, the J&K govt. would need to
extend coverage to more people, offer more services, and/or pay a greater part
of the cost. In J&K allocations for healthcare and medicines are scattered
and fragmented between two directorates of health services, two government
medical colleges, two government dental colleges, directorate of ISM, two
super-speciality hospitals. All these funds need to be pooled and utilized centrally
for increasing efficiency and conserving the available resources. However
contingency grants for meeting emergent needs need to be kept available at the
hospital/medical college level too for seamless availability of medicines.
WHO
recommends centralized procurement and decentralized distribution of medicines
and devices for which we need adequate funding, trained manpower, modern infrastructure laced with
MIS, state-of-art warehousing, dedicated
transportation, modern storage and distribution facilities at all district
headquarters of J&K. J&K Medical Supplies Corporation Ltd has been
assigned these responsibilities in the region over the past few years. Though
healthcare schemes sponsored by the union government like Swasth Bharat
Abhiyan, Ayushman Bharat, Arogya Nidhi, Pradhan Mantri Swastha Bhima Yogna and
their inter-linked schemes like JSY, JSSK, RBSK, RBSY etc have brought
considerable relief to a sizable section of the population living below the
poverty line in J&K, majority of the population still remains uncovered by
any health insurance schemes that is significantly hampering our progress
towards Universal Health Coverage. Furthermore govt. of J&K has opened a chain
of Jan Aushadhi and AMRUT drug stores across the length and breadth of J&K,
where cheap yet standard quality generic medicines are made available to the
patients, there is a lot more than needs to be done since their existing number
is not yet proportional rather nowhere near to the actual need.
In view of considerable gains made in the
healthcare sector in the recent past this author is contemplating to undertake
a study in J&K state in order to analyze the situation on ground vis-a-vis
availability, financial accessibility, geographical accessibility,
affordability and acceptability of healthcare services particularly essential
medicines at public health facilities of Jammu and Kashmir with an aim to
identify the gaps, barriers, prospects and challenges towards adopting and
implementing universal health coverage. Subsequently a comprehensive policy
framework covering all relevant aspects concerning UHC including health service delivery, health workforce, health information systems,
access to essential medicines, health systems financing, leadership and
governance shall be developed that shall lay a roadmap for future policy
direction of the J&K government towards implementing Universal Health
Coverage scheme here. This study will provide the necessary impetus and
direction for making UHC a reality in J&K in near future.
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