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Day 30 – Q 2.What are the challenges in implementing a state sponsored healthcare scheme having universal coverage? Analyse.

2. What are the challenges in implementing a state sponsored healthcare scheme having universal coverage? Analyse. 

सार्वभौमिक कवरेज वाली राज्य प्रायोजित स्वास्थ्य योजना को लागू करने में क्या चुनौतियाँ हैं? विश्लेषण करें।


The ultimate goal of Universal Health Coverage (UHC) is to ensure that everyone, everywhere, should have access to essential healthcare services without facing financial hardship.


India’s commitment towards achieving UHC is reflected in policies and institutional mechanism, which are directed towards increasing coverage and access to health services. India has taken many steps to achieve UHC such as Ayushman Bharat, but still many challenges exist such as,

  • Funds: Cost of Providing UHC is far greater than government estimates. India’s public health expenditure is amongst the lowest in the world, India currently spends a little over 1% of GDP on health. Considering public and private expenditure on health, the feasibility of UHC seems to be concerning in tandem with the current economic reality of India.
  • State Cooperation: Health is a state subject. State cooperation is a must for UHC. With states and UTs like West Bengal and Delhi keeping themselves out of Ayushman Bharat Scheme, creates a challenge for UHC. 

  • Infrastructure: Lack of adequate infrastructure is a concern which includes proper hospital infrastructure, number of beds and diagnostic centres.
  • Professionals and Staff: In India, the doctor-population ratio stands at just 0.62:1000 as against the WHO recommended a ratio of 1:1000. Moreover, there is lack of sufficient capacity of well-trained Nurses and other supporting staff to fulfil the high demands. Denial of qualified doctors and skilled medical personnel to serve in rural areas is also a challenge which creates a rural-urban divide in the health sector.

  • Participation of Insurance companies:  There are concerns about fair play and efficiency. Government insurance companies do not perform effectively and private insurance companies do not provide holistic coverage of diseases. Indian health insurance covers only hospitalization costs and other expenditures like clinical visits, diagnostics and medication are not covered.

  • Changing pattern of Diseases: There is an epidemiological transition from communicable towards non-communicable diseases such as hypertension, diabetes and mental illnesses.
  • Private participation: Currently almost 70 per cent of our healthcare needs are met by the private sector. Feasibility of empanelling private healthcare in UHC is a major task to be done as private sector feel that the prices fixed by the government are far below market rate and it would be unsustainable to operate at such costs while providing high-quality outcomes. 
  • Awareness and Behavior: Most of the time people are not aware of government initiatives and schemes. Moreover, people take symptoms for granted and does not consult the doctor at the earliest and prefer taking medicine from the medical shop without prescription. Illiteracy plays a major role in it. 
  • Resistance Development: People are rapidly developing Multi-Drug Resistance in cases of Tuberculosis. 

Way Forward:

  • Strengthen both rural and urban public health infrastructure, human resource capacity and service delivery at all the three levels i.e. primary, secondary and tertiary.
  • Strengthen regulatory framework such as IRDA for insurance companies.
  • Raise the percentage of GDP allocated to health from 1.2% today to 2.5% by 2022.

  • Inform people and spread awareness about government initiatives in the health sector.
  • Incentivize medical personnel to work in rural areas.
  • Private hospitals participation is a must for UHC.


India cannot realize its demographic dividend without its citizens being healthy. UHC is expected to reduce social inequities and is also must for achieving the 17 UN Sustainable Development Goals (SDG’s) by 2030.

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