Tuesday, June 30, 2015

How do we talk about Universal Health Coverage?

Where health provisioning is concerned, Universal Health Coverage (UHC) has been the defining term for the past few years. WHO has taken it up with enthusiasm and the Indian government likes the word a lot too. In fact, recently Karnataka announced that it had achieved UHC!

I was at a meeting organized by WHO earlier this month, where a film was screened that talked about what UHC 'was' and 'was not'. But there were few specifics and all the visuals focused on antenatal and postnatal care. It is true that we, especially in India, have not yet achieved these basic targets. An example - the Community Health Centre (CHC) in Pisawan, where Sangtin Kisan Mazdoor Sangathan (SKMS) is active, does not have access to running water and its sole hand pump stopped functioning 2 years ago. Recently, a woman in labour left the CHC to find a place to urinate (the toilets there are always locked). She ended up delivering there.

But can UHC remain limited to ante- and post-natal care, deliveries, immunizations and some communicable diseases? When people have to go elsewhere for their other health needs, they will not necessarily return to government services for these. Barely half a kilometre from the Pisawan CHC is a private practitioner that even the poor in these parts rely on. He most likely does not have an MBBS degree (those who do display the information proudly!). A few years ago, he sat in a small shop-front clinic. Now he has an immaculate waiting room, a ward of sorts with a few beds and an examination room. Once as we waited to speak to him, he examined patients with all kinds of symptoms with the attention and 'human touch' that they do not get in the CHC. He wrote up long lists of medicines for most of them. This is the health care most Indians rely on.

To move from what we have to a system that promises true UHC (many health activists instead use the term Universal Access to Health Care), we have to better explain what we envision. I hope to work more on this in the coming months...


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