Providing universal health service coverage so that every individual would achieve health gain from a health intervention when needed by appropriate provisioning of health services. WHO devoted the World Health Report 2010 to “Universal Coverage” to highlight the conviction that access to and utilization of services according to need is a critical challenge everywhere (and probably the biggest challenge India faces). WHO has contributed to the report by the High Level Expert Group (HLEG) on Universal Healthcare Coverage established by the Planning Commission.
WHO will play an important role in: (i) dissemination, technical and policy advice by creating and sustaining a sense of urgency and a strong drive from the Report to implementation; (ii) advocacy for raising key technical aspects higher on the political health policy agenda, including development of common IT/HMIS standards in the public and private sector; and (iii) emphasizing quality standards, as well as embedding monitoring and evaluation in the reform implementation process.
WHO will also support the Government in helping stakeholders assess the services to be covered, starting from a review of the existing vertical services arrangements and health programmes, a number of which have already been integrated under the NRHM. The GoI is committed to increasing the number of affordable, efficiently networked and sustainable quality services to provide cover for the entire population and up scaling the necessary workforce accordingly. To facilitate this, feasibility studies are needed to examine the coverage of different packages.
A health technology assessment-inspired mapping exercise will thus be implemented addressing the personal and population health services that should be produced (profiles, not necessarily full details), their numbers and target populations, the delivery approaches and quality standards, service structures and organizations. If measured by the results obtained in the OECD countries and many countries in transition to higher development stages, primary health care services should be a clear priority in India. The fact that they are not covered under the Rashtriya Swasthya Bima Yojana (RSBY) but only through the National Rural Health Mission (NRHM) makes them especially relevant for UHC as stated in the report of the HLEG on UHC. One lesson learnt from the experience of other countries is that a unified IT system (or at least one with common standards so that different systems can “talk” to each other) is a critical prerequisite for fast, efficient progress towards a universal health financing system. Most importantly, while some aspects of reform implementation can proceed step-by-step, the IT/HMIS must not; standards and architecture have to be identified to avoid an over-fragmented reality that will be very difficult to put right a few years from now.