PHM-Exch> Universal health coverage (7)

[Claudio Schuftan]

   From:    kavbha at gmail.com   India

Everyone is "theoretically" covered to some extent in rural India with the
National Rural Health Mission that offers a fixed package of services for
free. That is, provided everyone can get past the limitations of social
exclusion (caste and class biases), gender biases at home and sometimes
simple geographical distance from the nearest health centre.

Would insurance improve the coverage for those excluded now? We do not know.
Still the coverage is better in some states in some ways than before the
Scheme. But universal coverage? It is "theoretically" existent and
practically difficult even when services are free for all.

With reference to  the "payment for services" model, it is being applied
under this Scheme for the Community Health Workers (called ASHA ). Early
evidence in some states shows that this has resulted in directing the focus
of CHW efforts more towards the higher paid services like facilitating
institutional deliveries to the detriment of other services.

On the other hand, better attendance of doctors is seen now after an
increase in salary scales.
The point-one fix for all may not work.

 Policy fixes for all nations may not work, particularly if not backed
politically.

Univeral coverage seems more likely if attempted locally. When planning and
implementing any steps for widening coverage, the powers-that-be must ensure
that everyone is informed and avenues for involvement during implementation
are localised to the extent possible.
In the National Rural Health Mission of India, this has been attempted by
involving local representatives by way of Health and Sanitation
Committees. Such attempts must be strengthened largely for any policy
changes in health services or even insurance to become truely universal.

Kavita Bhatia
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