Universal health coverage

The COVID-19 pandemic is a harsh reminder for the global community to reflect on the importance of the universal health coverage in effectively responding to health emergencies to protect lives and livelihoods. The pandemic situation exposed the lack of preparedness of India and its states to deal with the crisis. Poor access of the vast majority of the population to even basic healthcare facilities compounded the accumulated shortcomings. Assam recording 1,000 deaths due to COVID-19 infection and almost double the number of patients dying due to complications arising post-COVID-19 recovery has many lessons to learn. The state still having over 3,500 COVID-19 active cases and adding about 150 cases daily is also an indicator of how much of the healthcare facilities are available for treatment of non-COVID diseases.

The global observance of the "International Health Coverage Day 2020" on this day is the perfect occasion to take stock of the state health profile and plan accordingly for the future. This will help Assam make meaningful contribution to realization of the objective of the global day. The observation of this international day began in 2012 with the United Nations General Assembly endorsing a resolution urging the countries to ensure that everyone should have access to quality and affordable healthcare. The National Health Profile 2019 published by the Central Bureau of Health Intelligence of the Ministry of Health and Family Welfare reveals that the state has huge gaps to bridge despite making steady progress. Among the north-eastern states, the per capita health expenditure in Assam is the lowest at Rs 1546 as compared to the highest of Rs 5862 in Mizoram. Comparison of the data with the national average often depicts a misleading picture and achievement figures above the national average gives rise to complacency even the figures remain much below achievements of the best performing states.

Average medical and non-medical expenditure for every hospitalization case in urban areas in the state is Rs 52368 and Rs. 8520 in rural areas. Setting up of new medical colleges in past one decade in the state has resulted in significant rise in number of about 4000 new doctors to bring the total to close to 24000 from about 19,000 in 2010. Andhra Pradesh added about 40,000 new doctors and Gujarat about 20,000, Maharashtra added about 30,000 new doctors in this period. The disaggregated data of the national profile reveals a clearer picture of health access on ground. As on March 31, 2018, the rural areas of Assam had less than 1,400 doctors at the Primary Health Centres (PHC), only 158 specialists at the Community Health Centres, 106 male health assistants, 308 female health assistants, 2665 male health workers and 10,230 female health workers including Auxiliary Nurse Midwife (ANM). Directorate of Health Services data show that the state has 1014 PHCs, 151 CHS, 4621 sub-centres, 25 district hospitals and 14 sub-divisional hospitals. Each sub-centre is run by one female health worker/ANM and a male health worker caters to a population of 5,600. Each PHC should have four to six beds and acts as the referral unit for six sub-centres to cater to a population of about 35000, but many PHCs do not have four beds.

A PHC is to be headed by a medical officer and supported by 14 paramedical staff and shortage of the required staff deprives the rural population from timely medical attention and care. The state with 3.12 crore population (2011 Census) has 1176 rural government hospitals including the PHCs with only 11,000 beds to cater to 2.68 crore rural population. Compared to this, 50 urban government hospitals in the state has more than 6,000 beds and cater to 43.98 lakh urban population. Disparity in rural and urban healthcare access is a pointer of exclusion of a vast majority of rural population from access to quality healthcare. Besides, inadequate government healthcare facilities compel a major section of the state population with limited household income to seek medical care in private hospitals in and outside the state which drains their savings. Strengthening of the public sector health infrastructure in rural Assam is crucial to end the disparity. However, this will require significantly raising the State government's expenditure in healthcare, more particularly in rural areas. This will be possible only when central funding to the state is substantially increased. Equal attention has to be paid on increasing the proportionate number of trained human resource to smoothly run the new hospitals and healthcare centres. The National Health Policy envisages assuring availability of free, comprehensive primary health care services, for all aspects of reproductive, maternal, child and adolescent health and for the most prevalent communicable, non-communicable and occupational diseases in the population. Leveraging the digital technology can help real time mapping of the health-care deficit areas and identifying the gaps in access to ensure universal health coverage.