In 2020, a crisis hit that no country was prepared for and exposed one of society’s great fault lines: the chronic failure to adequately invest in public health and ensure universal health coverage.
The COVID-19 pandemic exposed the weaknesses and flaws in health systems everywhere. India has felt the brunt acutely as the world’s second worst-affected country in terms of confirmed cases of COVID-19 (at the time of writing). Although the country has had some successes in tackling the pandemic, COVID-19 has underscored how a return to the status quo is unthinkable. Pandemic preparedness is the need of the hour for future events such as this – and without universal healthcare, countries will find themselves very much in the same position in future crises as they were during this one.
The importance of achieving universal health coverage has not been lost among India’s political leaders, nor the international community. In September last year, Prime Minister Narendra Modi outlined his “four pillars” towards realising universal health coverage in India aligned with the 2030 target of the Sustainable Development Goals (SDGs), at the United Nations meeting on Universal Health Coverage in New York City.
Later that year, Union Health Minister Dr Harsh Vardhan said “universal health coverage is key to the Sustainable Development Goals 2030 agenda and to which India is firmly committed. Access to medical products and creating an enabling legal and trade environment for the public are critical to achieving the SDGs.”
During the Modi administration, efforts to expand access to healthcare and improve public health have been launched – perhaps most notably the Pradhan Mantri Jan Arogya Yojana (PMJAY) or Ayushman Bharat. The scheme, while not free from controversy, has seen footfall of 28.1 crore at its 50,000+ health and wellness centres as of November 20 last month. Other high-profile schemes, such as ones designed to expand the digitisation of healthcare and rid the country of ills such as poor sanitation, have won international plaudits. Yet there remains work to be done – and nothing has underscored this like the pandemic.
Yesterday marked the launch of the Lancet Citizens’ Commission on Health, whose “primary mission will be to lay out the path to guarantee universal access to quality and affordable health care services to every Indian. The Commission will be led by four distinguished health and business leaders (co-chairs, mentioned alongside), who have brought together thirteen experts from academia, the scientific community, civil society, and private healthcare to serve with them on the Commission.” The Commission notes
“The pandemic has highlighted structural weaknesses in India’s health system, ranging from inadequate medical supplies and insufficient numbers of health-care workers in public hospitals to irrational treatments and profiteering by private hospitals. Out-of-pocket payments for health care in India continue to be among the leading causes of poverty for many households. In a country with low public spending per capita on health care relative to its middle-income peers, the COVID-19 pandemic has further eroded an already fragmented health system.”
Socioeconomic inequalities, along the lines of “caste, class, gender, geography, and community” according to the Commission, only exacerbate the country’s public health crises. With the economic fallout of the pandemic set to hit the most marginalised hardest, 400 million could find themselves steeped even deeper in excruciating poverty.
“This is a first of its kind consultative and participatory initiative that aims to chart socioeconomic parity through universal health equity,” said Biocon executive chairperson Kiran Mazumdar-Shaw. “It seeks to engage citizens from across the country and put them at the heart of the efforts to transform India’s health system and make universal health care a reality in this country. Our intent is to include Indians from all socio-economic strata in this crucial discussion so that their experiences and views can be integrated in the recommendations, thus ensuring a credible and comprehensive report at the end of the process.”
This truly is the need of the hour. For many in India, the reality is a dilemma or foregoing life-saving medical treatment or being driven into crippling poverty. In the 21st century, this is simply unacceptable. But to achieve workable solutions, the citizens must be foregrounded which is what the Commission seeks to do.
“The first Lancet India Series published in 2011 laid out a bold roadmap for [universal health coverage],” said Pamela Das, senior executive editor at The Lancet. This new Commission is an opportunity to renew and reconfigure that vision, and put the citizens of India at the heart of the process with a view to transform policy in India. We look forward to working on this important endeavour with our Indian colleagues.”
Attaining universal health coverage as a task is far from easy, especially in a country as demographically, and geographically diverse as India. But it is not an insurmountable task – and certainly not a task for the country to turn its back on.
We observe Universal Health Coverage Day 2020 every year, commemorating the date in 2012 that United Nations member states made a landmark commitment to make UHC a reality. This year, the message is clear: “early one year after the first COVID-19 cases, we must say goodbye to the status quo that got us here, and settle for nothing less than strong health systems that protect everyone—now and into the future.”
2020 witnessed health workers and hospitals stretched to and, in some tragic cases, beyond their breaking point. We saw people from all walks of life, from paupers to presidents, become debilitatingly sick and in some tragic cases losing their lives. We saw brutal economic damage, sparing few.
Amidst the worst, however, we also saw the best. We saw governments commit to health and make it a priority. We saw outpourings of support for frontline health workers, rightly acknowledging their acumen, dedication, fearlessness, and tiredness in the most difficult of circumstances. And we saw a pace of research and development in diagnostics, therapeutics and vaccines that highlighted for all to see the brilliance of our international scientific community.
Everyone pines for a return to normalcy, but when it comes to health, a return to normalcy is the exact opposite of what we need. Health must be at the top of the agenda. COVID-19 reminded us of the universalism of sickness; that we share the pain of when health systems are underresourced. India has felt that pain for decades. Without a concerted commitment towards universal health coverage, acting on the inputs of entities like the Citizens’ Commission, the pain will only get worse.
Find out more about The Lancet Citizens’ Commission on Health, click here.