Monitoring and evaluating progress towards universal health coverage in India

Abstract

Background Universal Health Coverage (UHC) is gaining in importance across the world. WHO defines UHC as ‘‘ensuring that all people can use the promotive, preventive, curative, rehabilitative and palliative health services they need, of sufficient quality to be effective, while also ensuring that the use of these services does not expose the user to financial hardship’’ [1]. While many countries have achieved UHC to a large extent, others are still on the path; India being one such country. Universal Health Coverage: The Policy Context in India UHC is not a new concept in India. The Bhore committee (1946) had recommended that India should have a health system that ‘‘is designed to provide [a full range of health care] for everyone who wishes to use it. ….everyone who uses the new service is assured of ready access to whichever of its branches he or she needs’’ [2]. However, since then the government has steadily diluted its promise of universal health care. In 1983, it only promised access to ‘‘universal provision of comprehensive primary health care services’’ [3] and in 2002, UHC became reduced to access to ‘‘universal immunisation services’’ [4]. The government’s flagship programme National Rural Health Mission (NRHM), launched in 2005, did include strengthening health services, but there was no mention of universal provision of health services [5]. It was only in 2011, when the government of India commissioned a High Level Expert Group (HLEG) that UHC once again entered the lexicon of health policy makers. The HLEG report recommended that India should achieve UHC by 2022 by increasing government finances and by strengthening provision of government health services [6]. This report was accepted by the Planning Commission and is