Achieving Universal Health Coverage in India: The Need for Multidisciplinary Public Health Action & Increased Investing In Human Capital and Infrastructure

New Delhi:  In recognition of World Health Day, the University of Chicago Center in Delhi hosted a virtual press conference to share the preliminary findings from the research studies conducted by the University of Chicago Faculty in India and their relevance to Universal Health Coverage.

University of Chicago faculty members shared insights from research on mental health, preventive and promotive health care, innovation and technology in health care delivery, engendering medical education, and health financing in the Indian context.

UChicago Faculty Panellists:

• Anup Malani, Lee and Brena Freeman Professor of Law; Professor at the Pritzker School of Medicine, The University of Chicago Law School 
• Mohan S. Gundeti, Professor of Surgery, Pediatrics, and Obstetrics and Gynecology; Director-Pediatric Urology
• Nishant Agrawal, Professor of Surgery; Chief, Section of Otolaryngology-Head and Neck Surgery; Co-Director, Head and Neck Surgical Oncology
• Osman Ahmed, Associate Professor of Radiology
• Seeba Anam, Associate Professor of Psychiatry and Behavioral Neuroscience
• Aniruddha Hazra, Assistant Professor of Medicine 

When asked about the policy recommendations from India’s perspective to achieve universal health coverage, Prof. Hazra said that we need to prioritize the health needs of India and the ways how health coverage can be applied to the particularly transgender population.   Prof. Malani stated the need for adequate supply and quality provided by the private sector, the need for insurance and the driving demand for the private sector to construct more health care facilities. Prof. Anam suggested that investment in youth mental health care should be increased. Prof. Ahmed emphasized on minimally invasive procedures which will help to expand the services available to patients. Prof. Gundeti suggested investing in human capital and infrastructure especially producing the equipment locally rather than importing it.

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Prof. Nishant Agrawal spoke about Prevention, Screening, and early Diagnosis of Oral Cancer in India and said that oral cancer accounts for around 30% of all cancers in India and the country has one-third of oral cancer cases in the world.  Unfortunately, there are no current screening techniques outside of physical examination and invasive biopsies to detect oral cancer. He also mentioned that DNA-based saliva screening can catch cancers in the early stage. These tests are painless which avoids the discomfort of biopsy, convenient and accurate, and validated. He stated that oral cancer is completely curable if diagnosed at an early stage.

Prof. Anup Malani talked about scaling health insurance: Role of public vs private sector in the Supply of Care.  He started with a background on India’s health care system and shared his study on Indian health insurance.  According to his study, less than 50% of children live in villages without healthcare facilities whereas the private sector provides 75% of health care. There is a limited demand of health care facilities, the healthcare spending is only 3-4% of GDP.  There is inadequate financing; 75% of healthcare spending is out-of-pocket, 25% untreated diseases are due to lack of financial support.  The Government has made a strategy to solve this issue including building hospitals, training doctors, running public health campaigns, etc. In 1990s, we witnessed a shift where private supplies expanded thematically. In 2000s, the Government changed its strategy and started supporting demands with states (Yeshasvini, Arogyashree Vajpayee), then central finances schemes emerged like RSBY and PMJAY. Despite the shift, demand subsidies are a small share of spending. He summarized the main findings on health outcomes are access and enrolment had huge significant positive effects on health.  The health insurance’s main value is not health but a financial protection from large expenses.  The clinically significant health effects (10% of SD) can also not be ruled out and there is a need for larger and deeper studies to find health impacts. The lesson learned from the findings are:

1. Health insurance has primarily financial benefits;
2. Charge higher income households to save government money;
3. Marketing is critical to uptake and utilization.

Prof. Aniruddha Hazra talked about the trans health landscape in India. He mentioned that transgender and gender non-binary persons in India face unequal barriers in accessing healthcare facilities.  These barriers are directly responsible for the inequities in health outcomes and access for this marginalized population.  There are major gaps in medical education in India regarding Sexual orientation, gender identity, expression, and sex characteristics competencies.  The initial data shows that transphobia and heterosexism are deeply ingrained in medical education in India, which, in a result impacts the ability to provide medically necessary care to this marginalized population; negatively affects students and trainees within the health care system. He urged the need to sensitize medical campuses on these issues.

Prof. Mohan Gundeti talked about how we can mitigate the morbidity of surgery in children universally and how morbidity can be reduced in children. With his team, a minimal invasive surgery in children was developed to reduce morbidity at the University of Chicago.  Since 2016, the team has done many workshops, seminars, training, etc. in India on minimal invasive surgery in paediatrics and have been sharing knowledge countrywide. The future plans include collaborating with various non-governmental organizations to develop this robust plan, adopting more minimal invasive surgery, there is also a need for infrastructure not only to train doctors but also to develop equipment locally in India.

Prof. Osman Ahmed spoke about improving trauma care and hemorrhage control with minimally invasive procedures using interventional radiology.  He stated that the traumatic injuries in India represent are health problems.  Traffic accidents are among the highest in the world and account for up to 18% of all deaths, among these traumatic injuries, up to 58% have been reported to be preventable and among these preventable traumatic injuries, hemorrhage is cited as a leading cause. The initial findings of the study are through strategic and collaborative efforts between trauma surgery and interventional radiology at the University of Chicago, a series of efforts and protocols have been initiated to improve care and outcomes for patients with significant hemorrhagic injuries.  The process has facilitated has allowed for the integration of interventional radiology techniques to help with non-operative management of certain injuries as well as aid in patients with ongoing suspected bleeding following surgery. The aim is to help advance trauma care in India through a collaborative symposium with key trauma surgeons and interventional radiologists in collaboration with AIIMS Hospital and University in Delhi and exchange information that will help identify processes where interventional radiology techniques can be employed to further improve outcomes for traumatic injuries in India.  This will be the first step towards developing a strong relationship with physicians from India to advance trauma care and improve outcomes in the region.

Prof. Seeba Anam talked about Resilience: Assessing Mental Health in South Asian Youth. She said that mental health conditions cause 1 in 5 years lived with disability and more than 80% people with mental health conditions don’t have access to quality and affordable treatment.  It is identified that stress, anxiety, depression are the most frequent concerns highlighted for youth population in India and are not properly addressed.  To do so, there is a need to fully integrate mental health plan in universal health coverage and the need of neglected people such as children should be addressed as about 9.8 million adolescents aged 13–17 years need active mental health care intervention.  The Government of India issued a program on Minding our minds during COVID 19 which addresses and promotes mental health concerns.  The recent data shows 1 of 7 youth has depression and unfortunately only 41% agrees to take help for mental health issues which is significantly less than other countries. She further stated that the need of the hour is to raise awareness about the importance of mental health across among people and human & financial resources for mental health should be brought in line with the needs which will be able to help to contribute to need assessment study.