Is access to health services universal? What are the potential barriers? Are there specific geographical areas or population groups for which access to health care is problematic? | India Is access to health services universal? What are the potential barriers? Are there specific geographical areas or population groups for which access to health care is problematic? | India

06 Jul 2022

Access to health services remains varied (Baru et al., 2010). Several equity indicators, such as gender, literacy, geographic location (e.g., rural versus urban), and socioeconomic status, influence this (Baru et al., 2010). These operate through complex inter-woven pathways of awareness (e.g., sensitivity to symptoms; services needed), availability (e.g., service provisioning at point-of-care; distance), affordability (e.g., public versus private versus unregulated/informal care providers; generalist versus specialist care), and acceptability (e.g., basket of choices offered, quality of care, provider profile). It has been observed that access is also determined by the profile of the health condition (Kasthuri, 2018). Those with minor ailments, for example, are likely to use care since this is available at the primary level at low cost without the need for specialist opinion and advanced diagnostics (Barik and Thorat, 2015).

Access to care is poor in the empowered action group states (states in central and north-central belt of India that have traditionally had poor health and development indicators) (Kumar and Singh, 2016). Access to care services is also challenging for the urban poor residing in slums and urban settlements (Gupta and Mondal, 2015).

With respect to access to particular health care services, maternal health care service delivery has been strengthened for pregnancy and childbirth related care; however, access to postpartum services and follow up, and care services for sick new-borns (especially institutionalised care) is patchy (Paul et al., 2011). Whereas geriatric care, including home-based care and institutional facilities for adults, is limited across the country, sparing the metropolitan cities (ARDSI, 2010).

The Government of India (GOI) is committed towards addressing these challenges and achieving the goal of Universal Health Coverage (UHC) for its population, especially for the poorest, through Ayushman Bharat (Ayushman Bharat-HWCs and Ayushman Bharat-PMJAY). The Government has also made efforts to cap the cost of items (such as essential scheduled drugs, certain medical devices, consumables etc.) and regulate establishments (the Clinical Establishment Act of 2010) to secure affordability and quality in the private health sector (Ministry of Law and Justice, 2010; National Pharmaceutical Pricing Authority, 2013). However, these have coincided with failure of the private health sector and single-doctor facilities to thrive and sustain. Since most of the urban care provision is delivered by the private sector and the per capita annual public budget commitment to health (and as proportion of the national GDP) (NHSRC, 2021) by India continues to be amongst the lowest in the world, the health sector is headed for complex evolution.


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