What India's route to universal health coverage can teach the world

The goal of universal health coverage (UHC) as stated in the UN Sustainable Development Goals (SDGs) is one of the most significant commitments to equitable quality healthcare for all. India moved a step closer towards our commitment to the SDGs, when in 2018 the country launched a national health protection scheme, Ayushman Bharat, to achieve UHC. The mission, through its Pradhan Mantri Jan Arogya Yojana (PMJAY) initiative, established 150,000 health and wellness centres (HWCs) and provides health insurance coverage to 40% of the country’s population - nearly 500 million people, or roughly the equivalent of the entire population of the European Union.

In its first year of implementation, Ayushman Bharat has reached close to 3.9 million Indians who have taken advantage of cashless treatment, resulting in a savings of $1.6 billion for the benefitting families. As such, progress towards the SDG is steady for a nation with 1.3 billion people.

But there are, in particular, significant challenges in the healthcare value chain, including gaps in healthcare infrastructure, a divergence between rural and urban geographies, an acute shortage of skilled workers and inadequate public funding, to name a few.

For India to take a winning leap and overcome these challenges, innovative partnerships and new investments are required across the health value chain. Here's how India can turn the challenges of providing UHC into opportunities:

A crucial component of Ayushman Bharat is the strategic purchasing of secondary and tertiary healthcare services from the private sector. While private healthcare caters to around 70% of India’s population, there is an estimated shortage of 160,000 additional hospital beds under the scheme. There are only 0.65 doctors, 1.3 nurses and 1.3 hospital beds per 1,000 people in the country. The desired requirement by 2034 for every 1,000 people is 2.5 doctors, 5 nurses and 3.5 beds - and to achieve this standard, an investment of around $245 billion would be required.

While India wants to increase public health spending from the current 1.4% its GDP to 2.5% by 2025, the deadline is still half a decade away. This is where we have a huge investment opportunity. A more cohesive approach that includes fiscal incentives will allow India’s healthcare to attract more long-term funding and private equity.

Global estimates reveal that only half of all countries have the requisite health workforce required to deliver quality healthcare services. Furthermore, the twin burdens of communicable and non-communicable diseases (NCDs) are projected to generate additional demand for 40 million health workers globally by 2030. India, too, requires twice the number of doctors, triple the number of nurses and quadruple the number of paramedic and support staff. Worse still, even if we meet the WHO’s benchmark of one doctor for every 1,000 people in the next six years, there is a large imbalance among individual states.

We have to align the vision of medical education with the vision of “one nation, one healthcare sector”. The National Medical Commission (NMC) 2019 Bill recognizes the much-needed reforms in medical education. However, the challenge lies in building capacity for training people in a short time. This needs to be addressed through more transformational public-private partnerships (PPPs), presenting another opportunity to develop and adopt e-learning models. In turn, these can strengthen continuous professional development and the building of groups of highly trained personnel, while also bridging rural-urban gaps.

Digital health has emerged as a game-changer in achieving UHC goals. India has taken rapid strides here and digital health is bringing healthcare within reach of 70% of our population residing in rural and remote areas.

It is encouraging to see India ranked 58th in the World Economic Forum’s Global Competitiveness Index 2018. In the report, 103 of the 140 economies measured score 50 out of 100 or lower for innovation capability. This gives India an edge, as we are positioned to not only bridge gaps in our healthcare delivery but also to have the capability to contribute to global UHC goals through our telemedicine and digital health tools.

Telemedicine in India is growing at a compound annual growth rate (CAGR) of 20% and is expected to reach a value o $32 million by 2020. With more than 420 million mobile internet users, integrated medical records, the provision of mobile-enabled diagnostic software and an integrated, online healthcare delivery system can be fast-tracked. India’s healthcare providers are already working on new frontiers of digital technologies. Machine learning, blockchain and AI will continue to strengthen India’s ability to engage effectively with other geographies towards achieving global UHC targets.

For UHC to become a reality, it is important to expedite steps beyond infrastructural interventions to include water, sanitation, nutrition and a healthy lifestyle.

The challenge is to incentivize wellness-seeking behaviour. An encouraging aspect of India’s commitment to UHC has been the active and participatory role of the government. From Poshan Abhiyaan, which aims to eliminate the malaise of malnutrition, to the Prime Minister’s call for a Fit India Movement, new emphasis has been given to multi-stakeholder engagements.

For a sustainable UHC model, maintaining a balanced trade-off between cost, quality and access to healthcare services is critical. A collaborative approach aligning patients, payers and providers, along with innovative partnerships, will hasten efforts to mitigate risks, drive impact, forge stronger social returns and achieve sustainable UHC targets.