Universal health coverage

 Public health is a state subject in India and the primary responsibility to improve hospital and other public healthcare infrastructure. Under the National Health Mission, the central government provides financial and technical support to state governments for providing accessible, affordable, and quality healthcare. While India has already achieved WHO recommended doctor population ratio, it is yet to achieve the nurse population ratio. National Medical Commission (NMC) data shows that there are 13.08 lakh allopathic doctors registered with the State Medical Councils and the NMC as in June, 2022. The central government informed the parliament that assuming 80% availability of registered allopathic doctors and 5.65 lakh AYUSH doctors, the doctor-population ratio in the country is 1:834. The WHO recommended doctor population ratio is 1:1000. Increase of 69% in Medical Colleges from 387 before 2014 to current number of 654, increase of 94% in MBBS seats from 51,348 before 2014 to 99,763 as of now and increase of 107% in Post Graduate seats from 31,185 before 2014 to 64,559 are key factors behind the country achieving the desired doctor to population ratio. Disaggregated data, however, reveals wide disparity among states. Besides, some health experts, underscores the need for finding out the actual number of doctors available by putting in place a system of updating data of doctors who have retired, died or migrated to other countries or stopped practising to check the ground realities. There are 35.14 lakh registered nursing personnel in the country which shows availability of nurses at the ratio of 2.06 nurses per 1000 population against the WHO recommended ratio of three nurses per 1000 population. Under the scheme ‘Development of Nursing Services’ funds are provided to States to upgrade Schools of Nursing into Colleges of Nursing and increasing allocation to states with deficient nurse population ratio will result in overall improvement in the national average. Apart from infrastructure, the NHM also provides support for availability of adequate human resources to improve availability and accessibility to quality health care, especially for universal health coverage. Every state achieving the WHO-recommended ratio of human resources in healthcare system can end regional disparity and ensure access to quality and affordable healthcare services for every section of the country’s population. Increasing insurance coverage is also increases affordability and reducing out-of-pocket expenditures. The Ayushman Bharat, Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) provides health coverage to 10.74 crore poor and vulnerable families for secondary and tertiary care up to Rs.5 lakh per family per year and 22.87 crore Ayushman Cards have been issued. Over 20.97 crore Ayushman Cards have been generated and more than 4.21 crore treatments have been provided to AB-PMJAY beneficiaries, Rs.49,469 crore worth treatment have been authorized and 26,267 private and public sector hospitals have been empanelled for treatment which speaks volume of the popularity of the scheme and benefits that have flowed. Ayushman Bharat-Health and Wellness Centres (AB-HWCs) scheme envisages to deliver comprehensive primary health care by transforming Sub-Health Centres (SHCs) and PrimaryHealth Centres (PHCs), both Rural and Urban, into Health and Wellness Centres (HWCs) to achieve Universal Health Coverage and so far 1.56 lakh HWCs have been set up across the country. The HWCs provide preventive, promotive, rehabilitative and curative care for an expanded range of services coveringcommunicable diseases, non-communicable diseases etc. The Ayushman Bharat Digital Mission (ABDM) has given a huge push to the country’s healthcare system towards achieving the goal of universal health coverage by leveraging digital technology. More than five lakh patients availed faster queue-less ‘scan and share’ Out Patient Department registration within five months of its roll out. The patients can scan the QR code of participating hospital using any health application of their choice such as ABHA (Ayushman Bharat Health Account) App, AarogyaSetu App, and share information like name, age, gender, and ABHA number with the Health Management Information system of the hospital for paper-less registration and instant token generation. The patient’s health records also get digitally linked to their ABHA which they can manage and access from their phone anytime anywhere. Such flexibility has made accessing healthcare services smooth and faster. The fact that the service has been adopted by 365 hospitals in 125 districts across 25 states within five months of the launch speaks volume about the dynamism the application of digital technology has brought and its adoption by more hospitals and registration of more health professionals will be a huge boon for patients and will be critical to achieving the objectives of transforming the healthcare system in the country into a robust digital ecosystem. Prioritizing human resources in healthcare sector has become urgent necessity to match the aspiration created by the digital environment among patients for quality healthcare services. States having comprehensive and updated database of healthcare workforce will be useful in drawing the roadmap of universal health coverage.