Viksit Bharat@2047: Why Universal Health Coverage is Necessary
Viksit Bharat@2047 has caught the imagination of a large section of thinking Indians. However, NITI Aayog’s paper titled ‘Vision for Viksit Bharat@2047: An Approach Paper’, released in July 2024, is not available on the website of the Aayog.
In two previous articles (here and here) we examined two important aspects of the vision. In this article we discuss the aspect of life expectancy by 2047.
The vision document, as reported in the media, stresses tangible improvements in many demographic aspects. It envisioned life expectancy of 84 years by 2047 from 71 years in 2023. Thus, the targets are quite ambitious, and business as usual approach will not deliver these ambitions.
Likely life expectancy
As per the July 2020 Report of the Technical Group on Population Projections published by Ministry of Health & Family Welfare, life expectancy at birth was projected to increase from 69.4 years in the quadrennial 2021-25 to 71.2 years in 2031-35 for males and from 72.7 years to 74.7 years for females. This is an increase in life expectancy of 2 years over a decade. Though it is known that with time, marginal increase in life expectancy would be smaller, yet assuming a similar pattern of increase beyond 2036, the life expectancy by 2047 would at best reach 75 years for males and 78 years for females.
It may also be appreciated that sample registration system based life expectancy, in 2016-20, in many large states like Madhya Pradesh (67.4 years), Uttar Pradesh (66 years), Chhattisgarh (65.1 years) etc., was much lower than the national average of 70 years.
Amongst major states, highest life expectancy was in Kerala (75 years) followed by Himachal Pradesh (73.5 years). So, the relatively poor states of north and central India have to formulate and implement policies which will result in improved life expectancy. This effort has to continue over the next two decades.
It is also germane that higher life expectancy does not mean much if the person is not healthy and economically productive. Last-mile reach of health services and dissemination of information on healthy living are therefore key prerequisites for a healthy India by 2047.
A recent Institute of Economic Growth working paper titled “Granular Evaluation of Public Primary Healthcare Accessibility in Rural India” (Dang et al), assessed that in 2018 in rural areas as a whole, more than 2/3rd sub-districts did not meet the population norms laid down for health sub-centres and primary health centres in the empowered action group states namely Bihar, Chhatisgarh, Jharkhand, Madhya Pradesh, Odisha, Rajasthan, Uttarakhand and Uttar Pradesh.
Moreover, the study “National burden estimates of healthy life lost in India, 2017” (Menon et al) found that disease/factor common in one part of India could be uncommon elsewhere. For instance, Year of Life Lost (YLL) rates from tuberculosis were found much higher in the north, particularly in Uttar Pradesh and Rajasthan, than in southern states. Diarrhoea YLL rates showed an east-west gradient, being much higher in Odisha, Jharkhand, Bihar, Uttar Pradesh etc. and comparatively lower in western India. Cancer YLLs were particularly high in north-eastern states, Haryana, Gujarat, Madhya Pradesh, Rajasthan, Uttar Pradesh, West Bengal, and in the southern states of Kerala and Karnataka. Obviously, this suggests state-specific prioritisation for disease control.
Extant infant mortality rates
Also, low Infant Mortality Rate (IMR) is an important parameter which determines life expectancy. As per National Family Health Survey 5 (2019-21), there is a wide chasm in the levels of IMRs across major states. Kerala and Tamil Nadu have IMR of only 4.4 and 18.6 respectively but Uttar Pradesh (50.4) and Bihar (46.8) occupy the other extreme. Kerala has outperformed many advanced economies including USA (5.5 in 2023) on this front.
China had IMR of 31.9 in 1999 which came down to 4.5 in 2023. In dollar terms, per capita current expenditure on health in China was 2.3 times that of India’ in the year 2000. The gap increased to 8.5 times by 2022.
Thailand is another success story as it has reduced its IMR to 8 in 2023 from 19.5 in 1999. Its per capita current health expenditure in dollar terms remains more than 4 times higher than India. It was achieved by providing Universal Health Coverage (UHC).
Conclusion
The desirability of improvement in the demographic targets is important if the economic target of USD 30 trillion economy has to be achieved by 2047.
The success of Thailand shows that it is possible to overcome the handicaps in providing better healthcare to its citizens. For this, the gap in financial and human resources has to be addressed. The insurance model currently being followed may not suffice to deliver envisioned health outcomes in rural areas. Political commitment to better health can ensure that the medical staff posted in PHCs and CHCs in rural areas and public hospitals at district level serve there and provide basic guidance on health and medical services to masses.
Sanjay Kumar and N. K. Sharma retired as Additional Director General and Director General respectively from Ministry of Statistics & Programme Implementation. Siraj Hussain is former Union Agriculture Secretary. Views are personal.
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