Universal Health Coverage Day 2022: More than half of households don’t use government health facilities

By: Yash Gupte

Inadequate quality of treatment is the most common reason for not using the public healthcare facilities at national level

The Ministry of Health and Family Welfare had organised a two day convention in Varanasi, Uttar Pradesh on December 10 and December 11, 2022 to mark the Universal Health Coverage Day 2022.  The theme of the event was “Build the World We Want: A Healthy Future for All”. UP CM Yogi Adityanath was present along with the health ministers of different states, Union Health Minister Dr. Mansukh Mandaviya and Governor of UP Anandiben Patel. The Universal Health Coverage Day is celebrated every year on December 12 to raise awareness for resilient health systems which are available to all. The day has been observed by the United Nations since 2017 and provides an opportunity for universal healthcare speakers to spread more awareness regarding healthcare facilities for all.

Adequate healthcare infrastructure is absolutely necessary for any country to develop and ensure that its citizens are fit and fine. In a country like India, a large chunk of the population depends on the public healthcare facilities provided by the government at different levels. The most basic healthcare facilities are available at the village or ward level in the form of primary healthcare centers. But in the past few years, it has been noticed that the people are not preferring to seek healthcare from the government healthcare facilities due to the poor condition of the public healthcare centers and the poor quality of healthcare facilities provided at such centers and hospitals. According to the National Family Health Survey-5, in 2019–21, 49.9 per cent of households did not regularly use a government health facility, which is a decrease from the 55.1 per cent observed in the NFHS's last round in 2015–16.

Though health is a state subject, the central government has launched a number of health related schemes for the welfare of the people at the grassroots level. Some of those schemes being the Ayushman Bharat Programme that provides for holistic and integrated health care and is the principal vehicle for achieving Universal Health Coverage (UHC), Pradhan Mantri Jan Arogya Yojana, Pradhan Mantri Swasthya Suraksha Yojana, Rashtriya Arogya Nidhi, and many more.

Most of the people particularly in the rural areas and the vulnerable sections of the society living in the urban areas depend on the public healthcare facilities for their treatment. The reason being the availability of government hospitals in the rural areas and the lack of private hospitals while in urban areas, it’s about the expensive treatment in the private hospitals.

Bihar had the highest percentage of the household that did not seek healthcare from government healthcare facilities from 2019 to 2021 (80 per cent), followed by Uttar Pradesh (75 per cent). Less than 5 per cent were found in Ladakh, Lakshadweep, and the Andaman and Nicobar Islands. Bihar reported a rise from 77.6 per cent to 80.2 per cent during the same time period, compared to Uttar Pradesh, where the percentage of households who did not regularly utilize a government facility fell from 80.1 per cent in 2015–16 to 75 per cent in 2019–21. Apart from Bihar, six other states and UTs saw a little increase in the percentage of such households. The state of Uttarakhand experienced the largest rise, going from 50.5 per cent in 2015–16 to 55.7 per cent in 2019–21. According to the survey, 46.9 per cent of families in urban areas and 51.7 per cent in rural regions used the public health sector during 2019–21, while 51.8 per cent of households in cities and 46.4 per cent in villages used the private health sector.

The reason behind people not preferring the government healthcare facilities in the above mentioned states is the lack of basic healthcare facilities and lack of service. Inadequate quality of treatment is the most common reason for not using the public healthcare facilities at national level. Additionally, the proportion of families that avoid using government institutions due to the "poor quality care" offered has not decreased. The primary deterrent to using government-run medical facilities, according to the NFHS-4 in 2015–16, was "poor quality of service." The lack of a government facility nearby (40 per cent of households) and the lengthy wait times at government facilities (46 per cent) are the next two most often cited factors. Also one of the most serious reason was the absence of the health personnel at the healthcare facilities.

The healthcare facilities in Bihar and Uttar Pradesh are far from satisfactory as these states lack even the basic facilities and many villages have been found without even a primary healthcare center. According to the audit report of the comptroller and auditor general of India, district hospitals in Bihar suffer from shortfall of beds, ranging from 52-92 per cent. As per the India Public Health Standards. “Actual bed strength was not raised to the sanctioned level (by March 2020) despite lapse of more than a decade,” report said, adding that doctors, nurses and other paramedic staff were also very less in number. Due to a lack of specialized specialists and basic infrastructures including buildings, medical equipment, furniture, and fixtures, 12 to 15 departments in the district hospitals did not offer medical test facilities, including cardiology, gastro, enterology, nephrology, and ENT. Out of the Rs. 10,743 crore, the Bihar Medical Services and Infrastructure Corporation Limited (BMSICL) could only spend 29 per cent, or Rs. 3,103 crore. Only 187 of the 1,097 projects started from 2014-20 could be finished.

In order to attract more people towards the public healthcare facilities and provide basic and adequate healthcare facilities to the grassroots level, rather than introducing new healthcare schemes, the government must concentrate on dispatch of services and improvement in the existing healthcare infrastructure.