Universal health care

PRESENTED BY : DR SABA
GUIDED BY : DR HEMANT KUMAR
1

UNIVERSAL HEALTH COVERAGE
Also called as*
 Universal Coverage
 Social Health Protection
 Universal Health Access
 Universal Health Protection
3
*The world health report: health systems financing: the
path to universal coverage-2010

THE CONCEPT
 Universal health coverage as a concept
was born in 1883 when Germany
introduced health coverage for
achieving health status of its young
population.
 Later, in 2005, World Health Assembly
adopted the term "UHC" and in 2010,
World Health Report focused on health
systems financing for countries to build
a platform for UHC
4*HLEG

 UHC is considered as a
standalone measure for
a country; as
conceptualized today
and attempts to provide
promotive, preventive,
diagnostic, curative and
rehabilitative services
without financial
hardships to its citizens.
 The world health report:
health systems
financing: the path to
universal coverage-2010
5
The world health report: health systems financing: the

DEFINITION:
Universal coverage (UC), or universal
health coverage (UHC), is defined as
“Ensuring that all people have access to
needed promotive, preventive, curative
and rehabilitative health services, of
sufficient quality to be effective, while also
ensuring that the use of these services
does not expose the user to financial
hardship”.
6
http://www.worldhealthsummit.org- 2013

This definition of UC embodies three
related objectives:
1. Equity in access to health services - those
who need the services should get them,
not only those who can pay for them;
2. that the quality of health services is good
enough to improve the health of those
receiving services; and
3. financial-risk protection - ensuring that the
cost of using care does not put people at
risk of financial hardship.
7http://www.worldhealthsummit.org -2013

8
*The world health report: health systems financing: the

Contd…
The global aspiration to
achieve UHC is evident as
countries having gross
domestic product (GDP)
less than that of India
have embarked upon and
adopted the concept.
China, Sri Lanka and
Bangladesh have also
adopted UHC and aim to
achieve 100% coverage in
times to come.
9

GLOBAL HEALTH SCENARIO AND
LEAD TO UHC
1948 Universal Declaration
of Human Rights states:
“Everyone has the right to a
standard of living adequate for
the health and wellbeing of
himself and of his family,
including food, clothing,
housing and medical care and
necessary social services.”
10

Contd.....
In 1966, member states
of the International
Covenant on Economic,
Social and Cultural
Rights recognised:
“the right of everyone to
the enjoyment of the
highest attainable
standard of physical and
mental health.”
11
http://www.refworld.org/docid/3ae6b36c0.html

Contd...
In 1978, Alma-Ata
Declaration
signatories, noted
that “Health for All”
would contribute
both to a better
quality of life and
also to global
peace and
security.
12

Contd...
 100 million people are
pushed into poverty
because of direct health
payments.*
 79 countries devote less
than 10% of general
government expenditure to
health*
 Health also frequently
becomes a political issue
as governments try to
meet peoples’
expectations
13*http://www.who.int/healthsystems/en/ Jun 2015

a. Member States of WHO
committed in 2005 to
develop their health
financing systems so
that all people have
access to health
services and do not
suffer financial hardship
paying for them.
b. This goal was defined as
universal coverage, or
universal health 14

The 2010 World
Health Report
builds upon the
2005 WHA
recommendations
and aims at
assisting countries
in quickly moving
towards Universal
Health Coverage.
15

India, is still attempting to
find a way for providing
appropriate, affordable and
accessible health care to
its population.
India was among the first
countries in the world that
enshrined in its constitution
the "socialist model of
health care for all”, being a
"Welfare state".
17

 The Bhore Committee
suggested the norms at the
time of Independence for
implementing this
philosophy but till date
India has been struggling
to achieve "health care for
all".
 Some progress was made
but the enormity of the task
presents huge challenges
for the public health system
across the country. 18

WHY IS HEALTH SYSTEM REFORM
NEEDED IN INDIA
19
 18% of all episodes in rural
areas and 10% in urban areas
received no health care at all*.
 28% of rural residents and 20%
of urban residents had no funds
for health care*.
 Over 40% of hospitalized
persons have to borrow money
or sell assets to pay for their
care *.
*http://www.frontierweekly.com/articles/vol-46/46-51/46-
51-Health%20Coverage.html

 Over 35% of hospitalized
persons fall below the poverty
line because of hospital
expenses* .
 Over 2.2% of the population
may be impoverished because
of hospital expenses*.
 The majority of the citizens who
did not access the health
system were from the lowest
income quintiles.
20
*http://www.frontierweekly.com/articles/vol-46/46-51/46-
51-Health%20Coverage.html

• India has Highest number of
malnourished and underweight
(46% under 3 yrs); children in
the world*
• Has high IMR of 50 per 1000
live births and MMR of 212 per
100 000 live births.*
• Has huge challenge to meet
national(MDG) goals of 28 per
1000 , (IMR) and 100 per 100
000 (MMR) by 2015.
Immunization coverage is
dismal > 44%*
21UHC: DR SABA
Source: World Health Organization (2011)

KEY HEALTH INDICATORS: INDIA COMPARED
WITH OTHER COUNTRIES
Indicator India China Brazil Sri Lanka
Thailand
IMR/1000 live-births 50 17 17 13 12
Under-5 mortality 66 19 21 16 13
Fully immunized (%) 66 95 99 99 98
Birth by SBA 47 96 98 97 99
(SKILLED BIRTH ATTENDANT)
22

Contd....
Rising burden of NCDs
2011 (in Millions) 2030 (in
Millions)
Diabetes 61 84
Hypertension 130 240
Tobacco Deaths 1+ 2+
23

 Health situation is not
uniform across India.18 year
difference in life expectancy
between Madhya Pradesh
(56 years) and Kerala (74
years)
 A girl born in rural Madhya
Pradesh, the risk of dying
before age 1 is around 6
times higher than that for a
girl born in rural Tamil Nadu
24
http://www.who.int/countryfocus/cooperation_str
ategy/ccs_ind_en.pdf

 Health expenditure is
largely out of pocket
(OOP) 67%.
 Public expenditure on
Health – 1.2% of GDP.
 Lack of an efficient and
accountable public
health sector has led to
the burgeoning of a
highly variable private
sector.
25HLEG-2011

LOW PRIORITY TO PUBLIC SPENDING ON HEALTH
INDIA AND OTHER COUNTRIES : 2009
26
Total public
spending as %
GDP (fiscal
capacity)
Public spending
on health as % of
total public
spending
Public
spending on
health as % of
GDP
India 33.6 4.1 1.2
Sri Lanka 24.5 7.3 1.8
China 22.3 10.3 2.3
Thailand 23.3 14.0 3.3
http://uhc-india.org/reports/hleg_report_chapter_2.pdf

 National programs like
National Rural Health
Mission (NRHM),
Rashtriya Swasthya
Bima Yojana (RSBY),
Janani Suraksha Yojana
(JSY), etc. have been
running in the country,
but they themselves are
insufficient to provide
and sustain UHC for the
nation at large.
27

 With demographic transition,
rise in burden of NCDs is
another major area of
concern. Dual burden of
diseases in the country poses
huge economic losses. An
emerging economy like India
cannot afford such losses.
 Therefore, urgent actions are
required to the reframe
existing infrastructure and in a
way to developments provide
UHC to the country.
28

High Level
Expert Group
(HLEG)
on
Universal Health
Coverage
(UHC)
29

Keeping in view the urgent requirement for
UHC , Planning Commission of India in
October 2010,constituted a High Level Expert
Group (HLEG) on Universal Health Coverage
(UHC):-
 to develop a framework for providing easily
accessible and affordable health care to all.
 review the experience of India’s health
sector
 and suggest a 10-year strategy going
forward
30

1. Develop a blue print for human
resource requirements to achieve
health for all by 2020.
2. Rework the financial norms
needed to ensure quality, universal
access of health care services,
particularly in under-served areas
and to indicate the relative role of
private and public service providers
in this context.
3. Suggest critical management
reforms in order to improve
efficiency, effectiveness and
accountability of the health delivery 31

4. Develop guidelines for the
participation of
communities, local elected
bodies, NGOs, the private or-
profit and not-for-profit sector
in the delivery of health care.
5. Propose reforms in policies
related to the production,
import, pricing, distribution
and regulation of essential
drugs, vaccines and other
essential health care related
items, for enhancing their
availability and reducing cost .
32

Contd..
6. Explore the role of
health insurance
system that offers
universal access to
health services with
high subsidy for the
poor and a scope for
building up additional
levels of protection on
a payment basis.
33

EVOLUTION OF THE REPORT
 Phase 1: An initial progress review
presented to the Planning
Commission at the end of January
2011.
 Phase 2: Interim recommendations
developed by the HLEG at the end of
April 2011.
 Phase 3: The final framework on
achieving Universal Health
Coverage for India was submitted on
the 21st of October, 2011
34

DEFINITION OF UNIVERSAL HEALTH
COVERAGE (UHC) BY HLEG
“Ensuring equitable access for all Indian
citizens, resident in any part of the country,
regardless of income level, social status, gender,
caste or religion, to affordable, accountable,
appropriate health services of assured quality
(promotive, preventive, curative and rehabilitative)
as well as public health services addressing
the wider determinants of health delivered to
individuals and populations, with the government
being the guarantor and enabler, although not
necessarily the only provider, of health and related
services.”
35

GUIDING PRINCIPLES FOR UHC
1. Universality
2. Equity
3. Non-exclusion and non-discrimination
4. Comprehensive care that is rational
and of good quality
5. Financial protection
36

6. Protection of patients’
rights that guarantee
appropriateness of care,
patient choice, portability
and continuity of care.
7. Consolidated and
strengthened public
health provisioning.
8. Accountability and
transparency.
9. Community participation
&
10. Putting health in people’s
hands
37

UHC : FOCUS AREAS
38
1.Human Resource Requirements
2.Access to Health Care Services
3.Management Reforms
4.Community Participation
5.Access to Medicines
6.Health care Financing
7.Social Determinants of Health

ADDITIONAL FOCUS AREAS
39
8. Urban health
9. Female Gender
10. Public-Private Partnerships
11. Information Technology-enabled
Health services

41
“Universal health entitlement for every
citizen - to a national health package
(NHP) of essential primary, secondary
& tertiary health care services funded
by the government”.
* Package to be defined periodically by an
Expert Group; can have state specific
variations

VISION OF HLEG FOR UHC
IT-enabled National Health Entitlement Card (NHEC)
42

PROVISIONING OF UHC
44
 Strengthen Public Services
(Especially: Primary HealthCare- Rural
And Urban; District Hospitals)
 Contract Private Providers (As Per
Need And Availability) – With Defined
Deliverables
 Integrate primary, secondary and
tertiary Care through Network of
Providers (Public; Private; Public-
Private)
Regulate and Monitor For Quality,
Cost And Health Outcomes

PRE-REQUISITES
 To achieve UHC, three basic prerequisites are of
paramount importance.
 Firstly, sufficient resources are needed to cater for
the health service requirements.
 Secondly, we need to reduce the financial risks and
barriers which obstruct the optimal usage of available
resources .
 Thirdly, we need to focus on increasing the capability
of the population to effectively utilize the available
resources.
45HLEG-2011

 Acknowledging the potential
of non-public sector in
achieving UHC.
 HLEG recognizes that only
public sector cannot aim to
achieve UHC. Representation
from private sector is also
required to provide services.
 These services can be
provided through two options.
46HLEG-2011

 In the first option, all those private
providers who enroll themselves
under UHC will provide minimum
75% of outpatient department
services and 50% of in-patient
services to those entitled under
NHP.
 The services will be cashless and
the provider will be reimbursed at
standardized rates.
 For remaining portion of services
available, the institutions could
accept payments or provide
services through privately
purchased insurance policies.
47HLEG-2011

 In the second option,
institutions enrolled under
UHC will provide only those
services, which are available
under NHP.
 There are pros and cons of
both the options. Rigorous
monitoring and supervision
will be required for smooth
functioning of any of the
options.
48HLEG-2011

• However, HLEG
envisages that over time,
every citizen will be
issued an IT enabled
National Health
Entitlement Card
(NHEC)
• This will lead to greater
equity, improved health,
efficient and transparent
health system and
further reduction in
poverty, greater
productivity and financial 49HLEG-2011

50
HEALTH FINANCING
AND
FINANCIAL PROTECTION

 Health finance is the
backbone of a self-sustaining
health care system.
 The per capita health
expenditure of our country is
far less than that of Sri Lanka
and China and is around a
third of that in Thailand.
 As a consequence, per capita
OOP expenditure in the
country has escalated to 67%
of total expenditure on health.
51HLEG-2011

 Inequity among states as
far as public spending on
health (Kerala stands at
Rs. 498 when compared to
Rs. 163 in Bihar) further
suggests an urgent need
for substantial changes in
current health care system.
 To streamline the health
care system, we need to
move from the concept of
insurance to assurance.
52HLEG-2011

HEALTH FINANCING AND
FINANCIAL PROTECTION
BY HLEG
53

1:Central government
and states should
increase public
expenditures on
health from the
current level of 1.2%
of GDP to at least
2.5% by the end of
the 12th plan, and to
at least 3% of GDP
by 2022
54

Projected Sharing of Health Expenditure by
Public and Private
55

2: Ensure availability of free
essential medicines by
increasing public spending on
drug procurement.
3: Use general taxation as the
principal source of health
care financing –
complemented by additional
mandatory deductions from
salaried individuals and tax
payers, either as a proportion
of taxable income or as a
proportion of salary.
56

4:Do not levy sector
specific taxes for
financing.
5:Do not levy fees of any
kind for use of health
care services under the
UHC.
6:Introduce specific
purpose transfers to
equalize the levels of
per capita public
57

7: Accept flexible and
differential norms for
allocating finances so
that states can respond
better to their needs.
8: Expenditures on
primary health care,
should account for at
least 70% of all health
care expenditures.
58

9:Do not use insurance
companies or any other
independent agents to
purchase health care
services .
10: Purchases of all
health care services
under the UHC system
should be undertaken
directly by the Central or
state governments .
59

11:All government funded
insurance schemes should,
be integrated with the UHC
system.
All health insurance cards
should, in due course, be
replaced by National Health
Entitlement Cards.
The technical capacities
developed by the Ministry of
Labour for the RSBY should
be transferred to the Ministry
of Health and Family
Welfare.
60

HEALTH SERVICE
NORMS
Recommendations
61

1:Develop a National Health
Package that offers every
citizen, essential health
services at different levels
of the health care delivery
system.
2.Develop effective
contracting-in guidelines
with adequate checks and
balances for the provision
of health care by the
formal private sector.
62

3:Re-orient health care
provision to focus
significantly on primary
health care.
4: Strengthen District
Hospitals.
5: Ensure equitable access
to functional beds for
guaranteeing secondary and
tertiary care.
63

6:Ensure adherence to
quality assurance
standards in the
provision of health care
at all levels .
7: Ensure equitable access
to health facilities in
urban areas by
rationalizing services and
focusing particularly on
the health needs of the
urban poor. 64

ACCESS
TO
MEDICINES, VACCINES AND
TECHNOLOGY
66

Millions of Indian households
have no access to medicines
as they can neither afford
them nor are these available at
government health facilities.
 Almost 74% of private out-of-
pocket expenditures today are
on drugs.
 Drug prices have risen sharply
in recent decades.
 India’s domestic generic
industry is at risk of takeover
by multinational companies.
67
http://www.searo.who.int/publications/journals/seajph/is
sues/seajphv3n3p289.pdf

 The market is flooded
by irrational, non-
essential, and even
hazardous drugs that
compromise health.
 Despite available
expertise and
technology, health care
system has been facing
a huge challenge of
providing essential
medicines and vaccines
to those who require it.
68

 Generic drug industry in India
provides lifesaving medicines
to many countries but at the
same time has been struggling
to increase access in our
country.
 This has resulted largely from
lack of reliable drug supply
systems, irrational
prescriptions, stringent product
patent regimes as well as
limited availability of public
health facilities 69www.who.int/whr/en/report04_en.pdf

RECOMMENDATIONS
1:Enforce price controls and
price regulation especially on
essential drugs.
2:Revise and expand the
Essential Drugs List.
3:Strengthen the public sector
to protect the capacity of
domestic drug and vaccines
industry to meet national
needs.
70

5: Set up national and state
drug supply logistics
corporations.
6:Protect the safeguards
provided by the Indian patents
law and the TRIPS Agreement
against the country’s ability to
produce essential drugs.
7:Empower the Ministry of
Health and Family Welfare to
strengthen the drug regulatory
system.
71

8.Central procurement
with decentralized
distribution has to be
followed.
Tamil Nadu model
has proven its
success and the
same needs to be
replicated on a large
scale.
72

 Required HRH were
recommended by Bhore
committee in 1948 up to
recent formulation of
Indian Public Health
Standards in 2010.
 The country holds
largest number of
medical colleges than
anywhere in the world.
Despite this, the country
faces acute shortage of
HRH.
74

• In contrast to WHO
recommendation of 25
health workers per
10,000 population, India
stands at 52nd rank with
19 health workers per
10,000 population.
• The distribution of
medical colleges is
skewed with Kerala and
Bihar as extreme
examples. 75

 In addition, the training
of health workforce
doesn’t address the
challenges of changing
dynamics of public
health.
 This is apparent form
the fact that the time
allotted to Community
Medicine during
internship has been
reduced from 3 months 76

 Launch of NRHM in 2005
gave a boost to the HRH
with creation of 8 lakhs
ASHAs with a target of
1/1000 population.
 But, availability of
qualified practitioners is
lacking with gross
shortage of doctors and
nurses . 77

HLEG
RECOMMENDATIONS
on HRH
78

There are two implications of the
recommendations:-
1. It will result in a more equitable
distribution
of human resources
2. can potentially generate around 4 million
new jobs (including over a million
community health workers) over the next
ten years
79

1:Increase HRH density to
achieve WHO norms of at
least 23 health workers per
10,000 population (doctors,
nurses, and midwives).
2.Establish a dedicated
training system for
Community Health
Workers under the aegis of
District Health Knowledge
Institutes(DHKIs)
80

7:Establish State Health
Science Universities to award
degrees in health sciences
and prospectively add
faculties of health
management, economics,
social sciences and
information systems.
8:Establish the National Council
for Human Resources in
Health (NCHRH) to prescribe,
monitor and promote
standards of health
professional education.
81

Health Service Management
and
Institutional Reforms
82

• Structural and functional
improvements are
prerequisites for
achieving UHC in any
country.
• With the dismal state of
key health indicators,
there is a need to
regulate the vast private
sector existing in the
country. 83

There is a need to
provide adequate
hospital beds. As per
World Health Statistics,
India’s hospital bed
capacity has remained
among the lowest in the
world at 0.9 beds/1000
population against
average of 2.9
beds/1000 population
globally.
84planningcommission.nic.in/reports/genrep/rep_uhc2111.

HOSPITAL BED CAPACITY, BY COUNTRY
85www.who.int/whosis/whostat/2011/en

Introduce All India and
state level Public
Health Service Cadres
and a specialized state
level Health Systems
Management Cadre in
order to give greater
attention to public
health and also
strengthen the
management of the
UHC system
86
MANAGERIAL REFORMS
HLEG 2011

INSTITUTIONAL REFORMS
Establish financing and
budgeting systems to
streamline fund flow: by
establishment of
National Drug
Regulatory Authority
(NDRDA) & National
Health Promotion and
Protection Trust
(NHPPT).
87HLEG 2011

a. National Drug Regulatory Authority
(NDRDA):
The main aim of NDRDA would be to
regulate pharmaceuticals and medical
devices and provide patients access to
safe and cost effective products.
b.National Health Promotion and
Protection Trust (NHPPT):
It will promote public awareness about
key health issues, track progress and
impact on the social determinants of
health, and provide technical expert
advice to the Ministry of Health
88HLEG 2011

Community Participation &
Citizen Engagement 89

 Primary health care without
community participation is
incomplete.
 For UHC, citizen engagement
needs scaling up for better
delivery of resources. ASHAs
have proved their worth under
NRHM.
 NRHM has shown a positive
effect on mobilization of
community through civil
society organizations and
Panchayati Raj Institution
(PRIs). 90
ASHA WORKER
HLEG 2011

 However, Village Health
and Sanitation
Committees and Rogi
Kalyan Samiti’s have
achieved limited
success.
 In addition, lack of
knowledge of available
health services hampers
their optimal usage by
the population.
91HLEG 2011

 Transformation of existing village
health committees into
participatory health councils is
required to be done.
92

Social Determinants
of
Health
93

 UHC cannot be
achieved until we
address social
determinants of health.
 The status of social
determinants including
nutrition, water and
sanitation, work security,
occupational health,
disasters, etc. remains
abysmal .
94www.who.int/contracting/UHC_Country_Support.pdf

RECOMMENDATIONS
1. Initiatives, both public and private, on the
social determinants of health and towards
greater health equity should be supported
2.A dedicated Social Determinants Committee
should be set up at the district, state and
national level
3. Include Social Determinants of Health in the
mandate of the National Health Promotion
and Protection Trust (NHPPT)
4.Develop and implement a Comprehensive
National Health Equity Surveillance
Framework, as recommended by the CSDH
95HLEG 2011

1: Improve access to
health services for
women, girls and other
vulnerable genders
(going beyond maternal
and child health).
2:Recognize and
strengthen women’s
central role in health
care provision in both
the formal health system
and in the home. 97HLEG 2011

3.Build up the capacity
of the health system to
recognize, measure,
monitor and address
gender concerns
through improved
monitoring .
4: Support and
empower girls, women
and other vulnerable
genders to realize their
health rights. 98HLEG 2011

 Broad agreement on the
financing model for
health-care delivery.
 Type and duration of
training for senior
functionaries in public
health,.
100
Challenge in fulfilling the objectives
of achieving UHC by 2022 :

 Entitlement package
and the cost of
health-care
interventions.
 Enactment of
National Health Bill
2009 as Health Act
and declining State
budget allocations for
public health.
101

Enrolling profit
making big
pharmacy
companies and
private health care
providers under
UHC will face a
huge opposition
from them .
102

Further,
enforcement and
acceptance of
Standard
Treatment
Guidelines (STGs)
to vast private
lobby remains a big
challenge
103

 The HLEG recommends having a
NHP. This will be through a
nationwide distribution of NHEC. A
difficult challenge as on December
2014, only 14.1% of Indians have
been issued PAN cards .
104http://www.incometaxindia.gov.in/PAN/Overview.

 Looking toward
reimbursement to the
contracted-in private
hospitals the issue
itself will face a lot of
resistance.
 As happened with
JSY, timely
reimbursement of
even Rs. 1400 for
beneficiaries was a
challenging issue.
105

The governments has
much higher capacities
to spend on health and
Political commitment
seems evident from the
fact that Prime Minister
of India, on the eve of
Independence day i.e.
15 Aug 2014 deaclred
health as “ Utmost
Priority.”
107

The Planning Commission has
acknowledged the same and recently
assured an increase in public health
spending to 2% of GDP from current
1.2% by end of 12th 5 years plan
108

 Global experience has shown that
Universal Health-Care is affordable
and feasible.
 Further, Clinical Establishments
(Registration Regulation) Act 2010,
Fundamental Right to Education Act
-2009 and Food Security Act- 2013
will help in reducing the burden of
illiteracy, poverty , unemployment and
disease .
109

CRITICAL ANALYSIS OF UNIVERSAL
HEALTH COVERAGE
 People may not value free services.
 Tax payers maybe unwilling to pay
extra taxes for the benefit of those who
cannot afford.
 Services beyond the scope of the NHP
will have to be borne by the individuals.
 Quality of services to those paying and
to the non-paying may differ.
 State specific recommendations have
not been laid out.
110

 The Indian people deserve, desire and
demand an efficient and equitable
health system which can provide UHC.
 This needs sustained financial support,
strong political will and dedication of
public health functionaries and other
stake holders as well as active
participation of the community .
112

UHC is the way to move beyond health
care. It is the way for providing health
assurance to the country’s population.
Challenges are ahead but consistent
efforts can achieve the goal of UHC.
113

REFERENCES
1. World Health Organization (November 22, 2010)."The world health report:
health systems financing: the path to universal coverage" . Geneva: World
Health Organization. ISBN 978-92-4-156402-1. Retrieved April 11, 2012
2. Planning Commission. High Level Expert Group report on Universal Health
Coverage for India; 2011.
3. http://www.worldhealthsummit.org/fileadmin/downloads/2014/WHS/Yearbook-
Essays/ WHS_Yearbook2013_Kieny.pdf
4. Singh Z. Universal Health Coverage for India by 2022: A Utopia or
Reality?Indian Journal of Community Medicine : Official Publication of Indian
Association of Preventive & Social Medicine. 2013;38(2):70-73.
5. Reddy KS, Patel V, Jha P, Paul VK, Kumar AK, Dandona L, et al. Towards
achievement of universal health care in India by 2020: A call to action. Lancet
2011;377:760-8.
6. Rao M, Rao KD, Kumar AK, Chatterjee M, Sundararaman T. Human
resources for health in India. Lancet 2011;377:587-98.
7. WHO. The World Health Report 2004: Changing History.Geneva: World Health
Organization ; 2004.
8. Dhingra B, Dutta AK. National rural health mission. Indian J Pediatr
2011;78:1520-6.
115

Contd..
9. Balarajan Y, Selvaraj S, Subramanian SV. Health care and equity in India.
Lancet 2011;377:505-15.
10.Savedoff WD, de Ferranti D, Smith AL, Fan V. Political and economic aspects
of the transition to universal health coverage. Lancet 2012;380:924-32.
11.Chauhan LS. Public health in India: Issues and challenges.Indian J Public
Health 2011;55:88-91.
12. Jindal Ashok Kumar . Universal health coverage: The way forward .Year :
2014 | Volume: 58 | Issue Number: 3 | Page: 161-167
13. International Institute for Population Sciences (IIPS) and Macro
International. National Family Health Survey (NFHS-3), 2005-06. Vol. 2.
Mumbai, India: IIPS; 2007.
14 .Evans DB, Etienne C. Health systems financing and the path to universal
coverage. Bull World Health Organ 2010;88:402.
116

Universal health care

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