The NDA government’s scheme to provide health cover of ₹5 lakh per year to 10 crore poor and vulnerable families through the Ayushman Bharat-National Health Protection Mission has taken a step forward with the Union Cabinet approving the modalities of its implementation. Considering the small window, just over a year, available before the term of the present government ends, urgent action is needed to roll out such an ambitious scheme. For a start, the apex council that will steer the programme and the governing board to operationalise it in partnership with the States need to be set up. The States, which have a statutory responsibility for provision of health care, have to act quickly and form dedicated agencies to run the scheme. Since the NHPM represents the foundation for a universal health coverage system that should eventually cover all Indians, it needs to be given a sound legal basis, ideally through a separate law. This could be on the lines of legislation governing the rights to food and information. Such legislation would strengthen entitlement to care, which is vital to the scheme’s success. It will also enable much-needed regulatory control over pricing of hospital-based treatments. The initial norms set for availing benefits under the NHPM, which subsumes earlier health assurance schemes, appear to make the inclusion of vulnerable groups such as senior citizens, women and children contingent on families meeting other criteria, except in the case of Scheduled Caste and Scheduled Tribe households. The government should take the bold step of including these groups universally; the financial risk can be borne by the taxpayer.
Universal health coverage is defined by the WHO as a state when “all people obtain the health services they need without suffering financial hardship when paying for them”. With its endorsement of the Sustainable Development Goals for 2030, India will have to constantly raise its ambition during the dozen years to the deadline. This underscores the importance of raising not just core budgetary spending every year, but paying attention to social determinants of health. Affordable housing, planned urban development, pollution control and road safety are some aspects vital for reducing the public health burden. Unfortunately, governments are paying little attention to these issues, as the quality of life erodes even with steady economic growth. In some of its early assessments on the road to universal health coverage, NITI Aayog advocated a State-specific approach rather than a grand national health system to expand access. But the NHPM has a national character, with States playing a crucial role in its implementation, and beneficiaries being able to port the service anywhere. It is a challenging task to make all this a reality, and the government will have to work hard to put it in place.
