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Ayushman Bharat being a pan-India universal healthcare insurance policy, many state governments are
implementing their own schemes. These states strongly believe in the psephological dividends these
schemes provide to them. Universal health care is feasible and sustainable if backed by a strong financing
mechanism. Recent interventions show the government’s share in total healthcare expenditure has
gradually increased. Schemes for universal health care in states like Andhra Pradesh, Tamil Nadu and
Maharashtra have provided valuable experience.

Similarly, RSBY implementation offers ample opportunity for the central and state governments to
learn from their experiences. The technological strengths are enabling Telehealth using
telecommunications infrastructure to reach the rural population. India’s rise to global power depends to
a considerable extent on her health progress, which can be achieved by reducing maternal and infant
mortality rates and vastly improving upon all the social determinants of health (Reddy et al.,2020).

4. Role of Primary Healthcare in UHC

The World Health Report 2008 – ‘Primary Health Care- Now More Than Ever’ (World Health
Organisation, 2008) – identified values and guidelines around primary health care for guiding the
development of health systems. The report advocated for four reforms aligned with PHC values to
narrow the gap between people’s expectations.
The first significant reform it advocated was in respect of universal coverage reforms that ensure
that a health system contributes to health equity, social justice and the end of exclusion, primarily by
moving towards universal access and social health protection;

The second reform, aimed at service delivery reforms - weaving health services around people’s
needs and expectations, making them socially relevant and aligned with the changing world, resulting
in better health outcomes;

The third reform was intended for public policy reforms that secure healthier communities by
integrating public health actions with primary care, and the fourth reform, called leadership reforms,
guaranteed inclusive, participatory, negotiation-based leadership.

The report further highlighted a health system aided by PHC values puts people at the centre of health
care. The healthcare system is built around an individual’s or community’s healthcare needs and expectations.
As per Ljubljana Charter on Reforming Health Care, 1996, Healthcare reforms must address citizens’ needs,
taking into account, through the democratic process, their expectations about health and health care. They
should ensure that the citizen’s voice and choice decisively influence how health services are designed and
operated. Citizens must also share responsibility for their own health ( World Health Organisation, 1996). The
report further elaborated, ‘citizen’s voice and choice should make as significant a contribution to shaping health
care services as the decisions taken at other levels of economic, managerial and professional decision-making’.

In the Indian context, we find that the goal of National Health Policy 2017 is in keeping with the
Sustainable Development Goal. If we look at the goal, we observe that the thrust of the Health Policy
2017 is preventive and promotive healthcare orientation (Ministry of Health and Family Welfare, 2017).
The driving force has to be primary health care.