Universal health coverage’s challenge

• The national conversation on India’s UHC often overlooks the complexity of multiple health systems and the unique challenges they bring.

• Government expenditure on healthcare varies significantly across states, with Himachal Pradesh, Kerala, and Tamil Nadu spending significantly more than Uttar Pradesh and Bihar.

• West Bengal, a predominantly rural State, has a low fertility rate but one of the highest teenage pregnancy rates (16%), which differs from other states with low fertility rates.

• West Bengal’s government health expenditure, which was ₹1,346 per capita in 2019-20, is only about 61% of the estimated ₹2,205 required to achieve UHC.

• West Bengal’s government health expenditure has been growing at 11% per annum over the last few years, but its out-of-pocket expenditure was high at 67% in 2019-20 and had only reduced by 2-3% from previous years.

• The implications of this are significant, as out-of-pocket expenditure accounts for a majority of health spending in most of the States.

• High C-section rates within the public sector in West Bengal negate the need and relevance of the State’s Swasthya Sathi scheme, which allows patients to seek care in private hospitals using the government’s limited tax resources.

• High blood sugar rates across West Bengal and similar trends in Bihar and Gujarat necessitate tailored health system strategies and region-specific public health messaging.

• A 58% shortfall in primary health centres and health and wellness centres in the State presents challenges in meeting the healthcare needs of its population.

• A holistic approach is essential, integrating public health initiatives, regional policy adaptations, and climate resilience, to build a robust and equitable healthcare system.