Context
- Health needs to be a central agenda for the G20 2023. It has been one of the priority areas for G20 deliberations since 2017, when the first meet of health ministers of G20 countries was organised by the German presidency. The G20 now has health finance in its financial stream and health systems development in the Sherpa stream.
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Background: Prioritizing Health
- An annual G20 meeting of health ministers and a joint health and finance task force reflects the seriousness the subject has gained.
- The Berlin Declaration 2017 of the G20 health ministers provided a composite approach focusing on pandemic preparedness, health system strengthening and tackling antimicrobial resistance.
- The Covid-19 pandemic gave added urgency to pandemic preparedness and the Indonesian presidency in 2022 made it the major focus. The Indian presidency needs to advance these agendas.
Global community engagement to strengthen Health systems
- Universal Health Coverage (UHC): The concept of UHC was born in the 2000s to prevent catastrophic medical expenditures due to secondary and tertiary level hospital services by universalizing health insurance coverage.
- UHC as a strategy to ensure healthcare for all: The UHC has been the big global approach for health systems strengthening since 2010, also adopted in 2015 as the strategy for Sustainable Development Goal-3 on ensuring healthcare for all at all ages.
- Limited impact of UHC: However, the limited impact of this narrow strategy was soon evident, with expenditures on outdoor services becoming catastrophic for poor households and preventing access to necessary healthcare and medicines, while many unnecessary/irrational medical interventions were being undertaken.
What are the new approaches developed to strengthen healthcare system?
- Highlighted the need to prioritise primary healthcare (PHC): In 2018, the Astana Conference organised by WHO and UNICEF put out a declaration stating that primary healthcare (PHC) is essential for fulfilling the UHC objectives.
- Combined UHC- PHC approach: In 2019, the UN General Assembly adopted the combined UHC-PHC approach as a political declaration.
- World bank report on benefits of PHC services during pandemic: The World Bank published a report in 2021, “Walking the Talk: Reimagining Primary Health Care After COVID-19”. The dominant hospital-centred medical system is becoming unaffordable even for the high-income countries, as apparent during the 2008 recession and subsequently.
What is PHC-with-UHC approach?
- It means strengthening primary level care linked to non-medical preventive action (food security and safety, safe water and air, healthy workspaces, and so on)
- It works through whole-of-society and whole-of-government approaches, and extending the “PHC principles” to secondary and tertiary care services.
- This could be the most cost-effective systems design the comprehensive game changer that global health care requires.
What is to be strengthened, what initiatives can be applied and how?
- Making health central to development in all sectors: Health in all policies, one health (linking animal and human health for tackling antimicrobial resistance and zoonotic diseases), planetary health, pandemic preparedness.
- Health systems strengthening: Designing PHC-with-UHC for diverse contexts. Conceptualised as a continuum of care from self-care in households to community services, to primary level para-medical services and first contact with a doctor, services provided as close to homes as possible, affordable and easily deliverable.
- Appropriate technologies to be adopted as a norm: By strengthening health technology assessment, ethics of healthcare, equitable access to pharmaceutical products and vaccines, integrative health systems using plural knowledge systems rationally.
- Health and healthcare from the perspective of the marginalised: Gendered health care needs, Health care of indigenous peoples globally, occupational health, mental health and wellbeing, healthy ageing.
- Easy access to health knowledge for all: decolonization and democratization of health knowledge, with interests and perspectives of low-middle-income countries (LMICs), prevention and patient-centred healthcare.
India’s G20 Presidency: An opportunity to contribute and make inclusive healthcare system
- India has several pioneering initiatives that can contribute to the PHC-with-UHC discussion:
- National Health mission and dedicated health facilities: Lessons from the National Health Mission for strengthening public health delivery; the HIV-control programme’s successful involvement of affected persons/communities and a complex well-managed service structure.
- Democratized health knowledge: Pluralism of health knowledge systems, each independently supported within the national health system.
- Certified Health personnel: Health personnel such as the ASHAs, mid-level health providers and wellness centres, traditional community healthcare providers with voluntary quality certification;
- R&D and widely acknowledged pharmaceutical capacity: Research designed for validation of traditional systems; pharmaceutical and vaccines production capacity;
- Digital health as an example: Developments in digital health; social insurance schemes and people’s hospital models by civil society.
Conclusion
- What is required is the drafting of PHC-with-UHC (a PHC 2.0) with a broad global consensus and commitment to a more sustainable and people-empowering health system. Pursuing such an agenda would involve much dialogue within countries, regions and globally. India should use its presidency to draft a model policy focusing on primary healthcare that commits to a universal, affordable, inclusive and just healthcare system
Mains Question
Q. What is Primary HealthCare and Universal healthcare integrated approach? What steps are necessary to further strengthen sustainable healthcare system? Discuss how India can contribute to it under its G20 presidency?
