*Image credit: independent.ng

United Nations General Assembly unanimously adopted a resolution on 12 December 2012 urging “Governments to move towards providing all people with access to affordable, quality health-care services without discrimination with a special emphasis on the poor, vulnerable and marginalized segments of the population.”

World health day is an opportune time and platform to demand implementation of the agreement to ensure #HealthForAll. This means ensuring that everyone, everywhere can access essential quality health services without facing financial hardship reiterating the idea of universal health coverage.

Universal health coverage (UHC) means that all individuals and communities receive the health services they need without suffering financial hardship. It includes the full spectrum of essential, quality health services, from health promotion to prevention, treatment, rehabilitation and palliative care.

Protecting people from the financial consequences of paying for health services out of their own pockets reduces the risk that people will be pushed into poverty because unexpected illness requires them to use up their life savings, sell assets, or borrow – destroying their futures and often those of their children.

What is not Universal Health coverage?  

Universal health coverage does not mean free coverage for all possible health interventions, it is not only about a minimum package of health services, but also about ensuring a progressive expansion of coverage of health services and financial protection. Universal health coverage is not only about individual treatment services, but also includes population-based services such as public health campaigns.

Status of Universal Health Coverage in India and Jharkhand
According to WHO, about 100 million people are still being pushed into extreme poverty (defined as living on 1.90 USD or less a day) because they have to pay for health care. As per the WHO In India the proportion of population with household out-of-pocket health expenditures Greater than 10% of total household expenditure or income is 17.3% which is among the highest in the world. (http://apps.who.int/gho/portal/uhc-country.jsp)  
In Jharkhand, average out of pocket expenditure per delivery in public health facility is INR 1476. Nine (9) districts in the state have out of pocket expenditure more than the state average. Chatra (INR 2985), Palamau (INR 2978), Garwah (INR 2230) and Dhanbad (INR 2213) have among the highest expenditure followed by Bokaro (INR 1958), Koderma (INR 1777), Ranchi (INR 1706), Ramgarh( INR 1605), Giridih(INR 1505),Lohardaga (INR 1435),Hazaribagh ( INR 1431), Khunti (INR 1326),East Singhbhum (INR 1149),Godda (INR 1120), Saraikela (INR 1067), Jamtara ( INR 1015), Gumla (INR 1003), Simdega (INR1001), Deoghar (INR 981), Latehaar (INR 965), West Singhbhum(INR 919),Sahibganj(INR 917), Dunka (INR 766), and Pakur (INR 721).

Challenges in achieving universal health care
Challenges in achieving UHC are insufficient funding, availability & efficiency of health workforce, erratic supply chain system coupled with inequity in financial allocation, availability of quality services and lack of transparent and reliable data management information systems. 

How can we achieve Universal Health coverage?  

Moving towards UHC requires strengthening health systems through improved health service coverage, trained health workers to deliver quality people-centered integrated care. Investments in quality primary health care will be the cornerstone for achieving UHC and investing in the primary health care workforce is the most cost-effective way to ensure access to essential health care. Good governance, sound systems of procurement and supply of medicines and health technologies and well-functioning health information systems are other critical elements of achieving Universal health coverage.


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